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HomeMy WebLinkAboutOpening of Bids - 2019 Curb & Sidewalk Construction Project No 119-004 - Premium Concrete Services IncCITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK Project Name 2019 Curb and Sidewalk Construction Project No. 119-004 mmITm For Bids Due May 14, 2019 at 9:30am Local Time PART I Date: 5 (Must completed for all bids. lease type oBidderr (Firm),- PP/�*l 1eA i print) icrG4—' 54- e5 �hc Address: 7/d2 57'TeC4 City/State/Zip: 116511Telephone Number:�0/96 —.. _.......y. _._.__._..... Agent of Bidder (if Applicable): .......... Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the public works project of: / Ytl p specifications prepared by: the it o South Bend, Indiana, in accordance with tans and e t ° mltA t u lG Wor 5 OlVi5ibn ci ications and dated mITmmm.. y'i/ for the sum of (enter the Total Bid as shown on the Proposal) r t� (Enter sum o"To al Base Bid�m plus Alternates shown o Pr¢ o�� u (� posal) (Nmerical) The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the notice. Any addendums attached will be specifically referenced at the applicable page. If additional units of material included in the contract are needed, the cost of units must be the same as that shown in the original contract if accepted by the City of South Bend. If the bid is to be awarded on a unit basis, the itemization of the units shall be shown on a separa attachment. By (Signature) ....... ....._ (Printed Name of Person Signing) The above bid is accepted this Subject to the following conditions: BOARD OF PUBLIC WORKS Gary A. Gilot, President Elizabeth A. Maradik, Member Laura L. O'Sullivan, Member ACCEPTANCE day of Genevieve E. Miller, Member Therese J. Dorau, Member Attest: Linda M. Martin, Clerk Version 1/17/2019 Contractor's Bid for Public Works - 2 20 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, 2019 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 1/ or Bid Bond. / Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely V 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 MBE/WBE Participation Goal Form [MWBE-1.0]. If minimum participation goal is not Ve met, also provide Evidence of Good Faith Efforts Form [MWBE-2.0] and MBE/WBE Contacted Form [MWBE-2.1]. l✓ Acknowledge Receipt of I 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. V/ 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. / l Bidder: Peepnk wl co.cvt4— Date: By Authorized Representative: Signature: Print Name & Title: Version 1/17/2019 Contractor's Bid for Public Works - 1 PART II (For projects of $100,000 or more — IC 36-1-12-4) These statements to be submitted under oath by each bidder with and as part of his/her/its bid. Attach additional pages for each section as needed. SECTION I EXPERIENCE QUESTIONNAIRE 1. Attach information regarding projects your organization has completed for the period of one (1) year prior to the date of the current bid. 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 bidder's capability for completing the project if awarded. Version 1/17/2019 Contractor's Bid for Public Works - 3 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) SS: . "tlll1T't ) The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury that: I. Contractor has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and 2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency; and 3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investment activities in Iran. a. For purposes of this Certification, "Iran" means the government of Iran and any agency or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from time -to -time. b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor is engaged in investment activities in Iran if either: i. Contractor, its successor or its affiliate, provides goods or services of twenty million dollars ($20,000,000) or more in value in the energy sector of Iran; or ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty million dollars ($20,000,000) or more in credit to another person for forty-five (45) days or more, if that person will (i) use the credit to provides goods and services in the energy sector in Iran; and (ii) at the time the financial institution extends credit, is a person identified on list published by the Indiana Department of Administration. Version 1/17/2019 Contractor's Bid for Public Works - 4 4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the Contractor subsequently learns is an unauthorized alien. Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of Contractor's newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3. Contractor's documentation of enrollment and participation in the E-Verify Program is included and attached as part of this bid/quote; and 5. Contractor shall require his/her/its subcontractors performing work under this public contract to certify that the subcontractors do not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the subcontractor subsequently learns is an unauthorized alien, and that the subcontractor has enrolled in and is participating in the E-Verify Program. The Contractor agrees to maintain this certification throughout the term of the contract with the City of South Bend, and understands that the City may terminate the contract for default if the Contractor fails to cure a breach of this provision no later than thirty (30) days after being notified by the City. 6. Persons, partnerships, corporations, associations, or joint venturers awarded a contract by the City of South Bend through its agencies, boards, or commissions shall not discriminate against any employee or applicant for employment in the performance of a City contract with respect to hire, tenure, terms, conditions, or privileges of employment, or any matter directly or indirectly related to employment because of race, sex, religion, color, national origin, ancestry, age, gender expression, gender identity, sexual orientation or disability that does not affect that person's ability to perform the work. In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials, or any combination of the foregoing including, but not limited to, public works contracts awarded under public bidding laws or other contracts in which public bids are not required by law, the City, its agencies, boards, or commissions may consider the Contractor's good faith efforts to obtain participation by those Contractors certified by the State of Indiana as a Minority Business ("MBE") or as a Women's Business Enterprise ("WBE") as a factor in determining the lowest, responsible, responsive bidder. In no event shall persons or entities seeking the award of a City contract be required to award a subcontract to an MBE/WBE; however, it may not unlawfully discriminate against said WBE/MBE. A finding of a discriminatory practice by the City's MBE/WBE Utilization Board shall prohibit that person or entity from being awarded a City contract for a period of one (1) year from the date of such determination, and such determination may also be grounds for terminating the contact for which the discriminatory practice or noncompliance pertains. 7. The undersigned contractor agrees that the following nondiscrimination commitment shall be made a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its agencies, boards or commissions. Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the performance of this contract with privileges of employment, or any matter directly or indirectly related to employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation, handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of contract. I, the undersigned bidder or agent as contractor on a public works project, understand my statutory obligations to the use of steel products or foundry products made in the United States (I.C. 5-16-8-1). 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 Version 1/17/2019 Contractor's Bid for Public Works - 5 may result in forfeiture of contractual payments. MM 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. h Dated this day of A\J , 2019 JANEE M TOWNER NOTARY PUBLIC SEAL ELKHART COUNTY, STATE OF INDIANA MY COMMISSION EXPIRES FEBRUARY 12, 2026 COMMISSION NO.710399 lam l urn N(Z C ntractor/l idde' (Firm) Haig ;�,ttu�re of �s�a,ttp �actor�'l'��ralder or Its Agent Printed Name and Title Subscribed and sworn to before me this 1 day of Iq _ , 20, 19 My Commission Expires cla jj:klaox, ......... ...... __...................................._....� No ry Public County of Residence .K n Version 1/17/2019 Contractor's Bid for Public Works - 6 BID/PROPOSAL CITY OF SOUTH BEND Project Name: 219 Curb and Sidewalk Construction ProjectNumber: 119-004 ........ .... . ....... .. . . ....... . .............. For Bids Due: May 14, 2019 at 9:30arn Local Time nY . ...................................... Contractor Name: 17renik^i c re- k_ ......................................................................... �Se.- L,,,;c e- 5 ...... . ......... Xn r- - . ........................... . . . DIVISION Al Item No. Description Quantity Unit Unit Price Total Amount T­ CONCRETE SIDEWALK, REMOVE SYS 0 0 1v0,0 > 2 CONCRETE SIDEWALK, 4-IN 364 Sys 00 3 CONCRETE CURB, REMOVE 1 603 LFT 4 1 CONCRETE CURB, MODIFIED . 603 LFT 6.1r. 00 5 CONCRETE APPROACH, REMOVE 50 SYS 1,0,0 0c) 6 ------ - ---- PCCP FOR APPROACHES, 6-IN 50 6!:F7 TOPSOIL AND SEEDING 454 SYS 1 TREE, REMOVE, 30 IN EA 2 e,4o, co ors 13 STUMP, REMOVE .............................. . . 1 EA 600.00 _oD r-> .6 PLANT, DECIDUOUS TREE, SINGLE 14 STEM, 2-IN TO 2.5 IN 3 EA 1 70O.Co �R / 00. 6>0 15 CURB RAMP, REMOVE 40 SYS .. . ........... tp�� -co o o IT-, ONE-WAY PERPENDICULAR CURB RAMP 8 SYS 17 PAIRED PERPENDICULAR CURB RAMP 16.0 SYS a to. oc> 18 DEPRESSED CORNER CURB RAMP 16�-�O .... ...... R;t0.00 DIVISION Al TOTA Ll DIVISION B1 Item No. Description Quantity Unit Unit Price Total Amount 1 ....... CONCRETE SIDEWALK, REMOVE 179 SY 35'-00 2 CONCRETE SIDEWALK, 4-IN -CONCRETE 179 SY 757,00 3 CURB, REMOVE . ...... ............ . . . .2_4_2 __ LF CONCRETE CURB, MODIFIED 242 5 M . ................. CONCRETEAPPROACH,R.................................................... 20 SY 00 00 L4 6 _PCCP FOR APPROACHES, 6-IN 20 —§-Y . . . .......Imp..........60 Z q00, 6 1:00� 7 TOPSOIL AND SEEDING 949 SY DIVISION B1 TOTAL$ q9 0,24-Co . . .. . ....... .. .... �J ............. DIVISION C1 Item No. Description ....... ..... ............. Quantity Unit Unit Price ................ Total Amount 1 CONCRETE SIDEWALK, REMOVE 320 SYS 106 ..... ........... ?_1R_ 8 e) - 00 2 CONCRETE SIDEWALK, 4-IN 320 SYS 3 ............ ... CONCRETE CURB, REMOVE 631 LFT CONCRETE CURB, MODIFIED 631 LFT 5 CONCRETE APPROACH, REMOVE 162 SYS 9,j:2 6 PCCP FOR APPROACHES, 6-IN 162 SYS 7 TOPSOIL AND SEEDING .. .............. 631 SYS 13 11 TREE, REMOVE, 30 IN 1 EA7 7F O.Oo �3 STUMP, REMOVE 1 EA ,3 .......... PLANT, DECIDUOUS TREE, SINGLE 14 STEM, 2-IN TO 2.5 IN 2 EA 15 CURB RAMP, REMOVE 32 ............... - �Sys ­SYS 17 .......... PAIRED PERPENDICULAR CURB RAMP 32 '?_e 0, 00 DIVISION C1 TOTAL Version 10/17/2017 Contractor's Bid for Public Works - 1 Project Name: Project Number: BID/PROPOSAL CITY OF SOUTH BEND 2019 Curb and Sidewalk Construction 119-004 For Bids Due: May 14, 2019 at 9:30am Local Timeq�' Contractor Name: '/"�e''t wa +�t r• _Sew mom. x .�.......................................... x. ' DIVISION C2 Item No. Description Quantity Unit Unit Price Total Amount 1 CONCRETE SIDEWALK, REMOVE 190 SYS o7® ,00 15,3A0, o0 2 CONCRETE SIDEWALK, 4-IN 190 SYS 6(,.oD /,2 f ,00 3 CONCRETE CURB, REMOVE 357 4 mm wwwµww 1 CONCRETE CURB, MODIFIED 357 LFT 5 CONCRETE APPROACH, REMOVE 40 SYS ,ap_wwww 6 PCCP FOR APPROACHES, 6-IN 40 SYS 12 7 TTO�PSOIL AND SEEDING 357 SYS 00 7 12, 00 11 TREE, REMOVE, 30 IN ........................._ _� 2 EA o pQ �� o PLANT, DECIDUOUS TREE, SINGLE STEM, 14 2-IN TO 2.5 IN 2 EA 7J®•oo �SDo .00 15 CURB RAMP, REMOVE 24 .._ SYS l�S,c� (00 ,OD ._.m.W.. 16 ....__ ONE-WAY PERPENDICULAR CURB RAMP 8 SYS 17 PAIRED PERPENDICULAR CURB RAMP 16 SYS DIVISION C2 TOTAL* -21 DIVISION D1 Item Description Quantity Unit Unit Price Total Amount No. 1 CONCRETE S IDEWALK, R E MOVE- 391 SYS �/,00 2 CONCRETE SIDEWALK, 4-IN ................................... 391 SYS C, ,00 .ao 3 1 CONCRETE CURB, REMOVE 370 LFT ,od 7 �lbO,00 4 _ � CONCRETE CURB, MODIFIED 370 LFT ��,00 Lc_,, 60 .._..........__.._. 7 _ � TOPSOIL AND SEEDING .. . ..... 370 _ .. SYS, m op o,00 11 TREE, REMOVE, 30 IN 2 EA 2o�,ao.a0, ob PLANT, DECIDUOUS TREE, SINGLE l 'LSD. d0 14 STEM, 2-IN TO 2.5 IN 2 EA 7�S,Gb 15 CURB RAMP, REMOVE 56 SYS -7;?,00 qa 3,2,0Du .. ....... ONE-WAY PERPENDICULAR CURB 1 S5, `'(&5 ®O 16 RAMP 24 SYS 06 . PAIRED PERPENDICULAR CURB RAMP --[-17 32 SYS,,00�(p...,o0 DIVISION D1 TOTALty 919,7S,U, DIVISION D2 Item Description Quantity Unit Unit Price Total Amount No. 1 CONCRETE SIDEWALK, REMOVE 188 SYS �S-oa7do, a� 2 T SIDEWALK, CONCRTE SIDEWA4E mm...�..._..IN _ 188 SYS , 00 ,00 ..... 3 � M ...... mm ... CONCRETE CURB, REMOVE_ 168 LFT ,00 3 62 00 4 CONCRETE CURB, MODIFIED 168 LFT ,00 0 2g, 00 5 w CONCRETE APPROACH, REMOVE 20 SYS (,0. Do oo , 00 6 PCCP FOR APPROACHES, 6-IN 20 SYS Iq,2 ,00 Q. oc? 7 TOPSOIL AND SEEDING 130 SYS 0, 00 J 3900'OP 15 CURB RAMP, REMOVE ... 16........ SYS 1100 ..... ........ .00 17 PAIRED PERPENDICULAR CURB RAMP 16 SYS o ,00 Oo DIVISION D2 TOTAL ty q2,12Y-00.. Version 10/17/2017 Contractor's Bid for Public Works - 2 Project Name: Project Number: For Bids Due: Contractor Name: ALTERNATE 1 BID/PROPOSAL CITY OF SOUTH BEND 2019 Curb and Sidewalk Construction 119-004 4„{J May .1�4,..2.0.1.9...at 9:30am Local Time � �......_...... � hem/e4m (foceG 5'e.-O Ce * . __. ---._.____ Item No. _Descri ------ Description p Quantit y U.n�...., t Unit Price Total Amount 1 CONCRETE SIDEWALK, REMOVE 101 SYS S, o0 2 CONCRETE SIDEWALK, 4-IN 101 SYS 3 CONCRETE CURB, REMOVE 172 LIFT DO 7or5_ 4 CONCRETE CURB, MODIFIED 172 LFT O,00 7 TOPSOIL AND SEEDING 172 SYS 8 TREE, 6 IN 1 EA oo S`SO . ob 10 ......_ .... TREE, REMOVE, 18 IN 1 EA _.. Sb 00 11 TREE, REMOVE, 30 IN 2 EA 13 STUMP, REMOVE 1 EA PLANT, DECIDUOUS TREE, SINGLE STEM, 2-IN 14 TO2.5IN 5 EA ALTERNATE 1 TOTAL 39 1 3470, od ALTERNATE 2 Item No. 1 ww_........................................... Description CONCRETE SIDEWALK, REMOVE _ .............. Quantity 80 Unit SYS Unit Price Total Amount 2 q DO, co 2 CONCRETE SIDEWALK, 4-IN 80 SYS ,ob S- o 3 ... CONCRETE CURB, REMOVE _ 130 LFT ....-...�....�................. 20. ®o 4 CONCRETE CURB, MODIFIED 130 LFT a oo ��.................. , ...-___ 7 ............ ............... TOPSOIL AND SEEDING 130 ......... SYS _.. 5,00 a 11 TREE, REMOVE, 30 IN 2 EA PLANT, DECIDUOUSTREE, SINGLE STEM, 2-IN /YSO.00 14 TO2.5IN 2 EAS,Ob Bidder (Firm): Pl'ea7iL-117 Conerclv-- Sc,v,G Address: %lam d 5-/ L + City/State/Zip: ALTERNATE 2 TOTAL ;Zdq ib , Telephone Number: del el 017(e By (Signature) (Printed Name of Person Signing) Version 10/17/2017 Contractor's Bid for Public Works - 3 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY{ DEVELOPMENT PROGRAM J FORM MWBE-1.0 MBEIWBE PARTICIPATIONw 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 orwoman business meets the qualifications of a Minority or Women's owned business. Project Number: 119-004 /� Project Name: 2019 Curb and Sidewalk Construction /' (_ 6i1G�G7�ill/GLS Total Bid Amount. MBENVBE Goal: Bidder: P# C��ar,rt . Page of Name &Address of MBE/WBE Primary Contact Person (Name(rele hone p ) Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of MBE/WBE Component m Percentage of Total Bid/Proposal pre.&ih, , Coieed-r— Y A&MOVOs 1&4,-,n -611 f $trViGts 3Tli7s15- .. . ....... .......... ........ s--7a Submitted by: A r*ce 1- ... �-- -- -------... .. -...._ Print Name ggtature Date Version 10/17/2017 Contractors Bid for Public Works - 4 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY' DEVELOPMENT PROGRAM` FORM MWBE-2.0y� EVIDENCE OF GOOD FAITH EFFORTS��tt;,,ti,� This completed form should be included as part of the Bids documents related to City of South Bend Public Works Projects requiring Good Faith Efforts to obtain MBEfWBE participation. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business as defined by the Indiana Department of Administration ("IDOA"), q Project Number: 119-004 Date: Project Name: 2019 Curb and Sidewalk Construction _.M..... Bidder: �!�✓hi (forrcrG�- SGrVrcc5 X-c- _...._.. _ _.....u. _..........w�......_ ....... ..._. Contact Person: key Telephone ... ..__ ..... ... / Address: 7l02 City: g State: Zip Email: f"►^e n/'CAwl 60,ncre_1e-0,)�/he To determine whether a bidder has demonstrated good faith efforts to reach the MBENVBE utilization goals set forth in the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or commissions, REQUIRE ALL of the following Good Faith Efforts as listed in the table below*: ....... EVIDENCE OF GOOD FAITH EFFORTS . MBE/WBE LIST(S): The bidder reviewed the City of South Bend's Minority and Women Business Enterprise Diversity Development Program, which uses the IDOA approved list of Minority and Women Owned Business as found on their website (hftp://www.in.gov/idoa), ACTION (ADVERTISE/CONTACT): In order for your bid to be deemed responsive, the City of South Bend requires 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 MBENVBEs reasonable time to respond. 3. Perform any and all necessary steps to provide written notice in a manner reasonably calculated to inform MBENVBEs of subcontracting opportunities and allowed sufficient time for them to participate effectively. 4. Utilize pre-existing services of available community organizations, small and/or disadvantaged business assistance offices and other organizations that provided assistance in the recruitment and placement of MBENVBE firms. **Bidder must circle or otherwise notate which of the two (2) required actions were performed. GOOD FAITH NEGOTIATIONS: The bidder negotiated in good faith with interested MBENVBEs„ H including providing such MBENVBE's with adequate information about the plans, specifications and other 1!� requirements of the subcontract and did not reject MBENVBEs as unqualified without sound business reasons based on a thorough investigation of their capabilities. SMALL CONTRACT(S): The bidder selected specific portions of the work to be performed by MBENVBEs in order to increase the likelihood of meeting the MBENVBE goals (including breaking down contracts into smaller units to facilitate MBENVBE participation) �.. _.. ......., ........_ CONTRACT RECORDS: The bidder has maintained the following records for each MBENVBE that has bid on the subcontracting opportunity: u� 1. Name, address, and telephone number; 2. A description of information provided by the bidder or subcontractor; and 3. A statement of whether an agreement was reached, and if not, why not, including any reasons for concluding that the MBENVBE was unqualified to perform the job., ......—_ *Proper demonstration of Good Faith Effort requires your initials next to all of the above boxes. Any omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of South Bend reserves the right to request additional information. Version 10/17/2017 Contractor's Bid for Public Works - 5 "t1 N Al A CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY° `nb DEVELOPMENT PROGRAM FORM MWBE-2.1 MBEIWBE CONTACTED ��° 1� 15 di" �1CC This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring contacted MBEIWBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business. PAGE OF Project Number: Project Name Bidder: 119-004 MBEMBE Participation Goal 2019 Curb and Sidewalk Construction lrUnII CA —WI Cvh gnatu (Title) (Date) MBE/WBE Firm Owner or Contact at MBE/WBE Firm Telephone: Fax: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBE/WBE FIRM; MBE/WBE Firm Owner or Contact at MBEIWBE Firm Telephoner Fax: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBE/WBE FIRM. Email: Email:. Version 10/17/2017 Contractor's Bid for Public Works - 6 rA1A Dow meint A3,1 OITM — 201 0i Bid Bond CONTRACTOR: (Name, legal status and address) Premium Concrete Services, Inc. 712 Richmond. St Elkhart, IN 46516 OWNER: (Name, legal status and address) City of South Bend Board of Public Works SURETY: (Name, legal status and principal place of business) Old Republic Insurance Company Brookfield, WI County -City Building Room 1316, 227 West Jefferson Blvd South Bend, IN 46601 BOND AMOUNT: Five Percent of the Total Bid PROJECT: (Name, location or address, and Project number, if any) 2019 Curb and Sidewalk Construction; Project No. 119-004 This document has important legal consequences. Consultation with an attorney is encouraged with respect to its completion or modification. Any singular reference to Contractor, Surety, Owner or other party shall be considered 5% of Total Bid plural where applicable. The Contractor and Surety are hound 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 perform, ance 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 tray accept the bid_ Waiver of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for an extension beyond sixty (60) days. If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor. When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the Project, any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein. When so furnished, the intent is that this Bond shall be construed as a statutory bond and not as a common law bond. Signed and sealed this 7th day of May 2019 = remit n Cc mta . ...:.ct Serva (Ps°irtcipaN) (Seal) (Title) -- Old 'epublic Insurance Company (Surety) t (Seal) (Title) 19norier L. Kasz (dj', AttornaV6t Fact CAtf Il"UN You sllnrauN sugn an originall^PJA Contract 1Docunnerritt, on wllltic this text appears uun RED. An olrugliunall assures that cllhanng ass wullt not Ilue obscured. Init.AIA " Document A3�tN �tt1CM. copyrtghtuu't9g3, tg?`0 and 2tN'tt7 by The American Institute of Architects. AYI rights reasarved. ti'UAt"f9�Nft�:'t"trls AtA Document N IGpoirt'of litu matte n°es U. . Cop yriglht ILaw and Iinternatioonal 11 ueattes, Unnautlluou paed uepiroduacttannt� or disb1butiorn of this AIA°0 Doo nnent, or° n.� :arote�ted it any utt In severe civil and ciriirruprall p)eruapties, arud Mill be prosecuted to tlhe rnaairnuarn extent p,uossilValle uruder tape Law, / Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright@aia.org. 061110 y May 7, 2019 RE: Premium Concrete Services, Inc. To Whom It May Concern: In compliance with the United States Department of Treasury's Listing of Certified Companies, this letter will serve to confirm that at this time the surety company Old Republic Insurance Company is listed with the United States Department of Treasury's Listing of Approved Sureties according to Department Circular 570. OLD REPUBLIC INSURANCE COMPANY Jennifer L. Kasznia Attorney in Fact jlk/ r www.Gibsonlns.com (( lb 1 (800) 814-2122 f (800) 836-2122 r South Bend, IN Plymouth, IN Indianapolis, IN Fort Wayne, IN Elkhart, IN Kalamazoo, MI k OLD REPUBLIC r INSURANCE COMPANY ... ... .. _.....__­,.... ........ ......................................................... 'r �r POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That OLD REPUBLIC INSURANCE COMPANY, a Pennsylvania stock insurance corporation, does make, constitute and appoint: NICOLE L BICKNELL, MEGAN E RIESENBERG, MARK EDWARD WOBBE, BARBARA E PEARSON, JENNIFER L KASZNIA, SANDRA L JUNK, WILLIAM J CERNEY, III, WESLEY MANTOOTH, THERESA BURNS, JORDAN SCHEIBER, CHERYL E. ALKIRE, OF SOUTH BEND, IN its true and lawful Attorney(s)-in-Fact, with full power and authority, not exceeding $50,000,000, for and on behalf of the Company as surety, to execute and deliver and affix the seal of the Company thereto (if a seal is required), bonds, undertakings, recognizances or other written obligations in the nature thereof, (other than self„insurance workers compensation bonds guaranteeing payment of benefits, asbestos abaternerit cor4ract bonds, waste manage- meat bonds, hazardous waste rernediallbn brands or biack lung blinds), as follows, ALL WRITTEN INSTRUMENTS IN AN AMOUNT NOT TO EXCEED FOUR MILLION DOLLARS($4,000,000)..... ---------------- ---- FOR ANY SINGLE OBLIGATION. and to bind OLD REPUBLIC INSURANCE COMPANY thereby, and all of the acts of said Attomeys-in-Fact, pursuant to these presents, are ratified and confirmed. This document is not valid unless printed on colored background and is multi -colored. This appointment is made under and by authority of the board of directors at a meeting held on March 14, 2014, This Power of Attorney is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the board of directors of the OLD REPUBLIC INSURANCE COMPANY on March 14, 2014. RESOLVED FURTHER, that the chairman, president or any vice president of the Company's surety division, in conjunction with the secretary or any assistant secretary of the Company, be and hereby are authorized and directed to execute and deliver, to such persons as such officers of the Company may deem appropriate, Powers of Attorney in the form presented to and attached to the minutes of this meeting, authorizing such persons to execute and deliver and affix the seal of the Company to bonds, undertakings reco nizances, acid suret ship obligations of all kinds, other than ba0 bonds bank deposftory bands, mortgage d�ef cJen wuy bonds„ morigage givaranty �onds„ guarantee o insk°aftent paper and note guaranty bonds. The said officers may revoke any Power of Attorney previously granted to any such person. The authority of any Power of Attorney granted by any such officer of the Company as aforesaid shall not exceed fifty million dollars ($50,000;000.00), except (a) bonds required to be filed as open penalty bonds, and (b) bonds filed with any court or governmental authority requiring an unlimited penalty in bonds filed in that court. RESOLVED FURTHER, that any bond, undertaking, recognizance, or suretyship obligation shall be valid and binding upon the Company (i) when signed by the chairman, president or any vice president of the Company's surety division and attested and sealed (if a seal be required) by any secretary or assistant secretary; or (ii) when signed by a duly authorized Attorney -in -Fact and sealed with the seal of the Company (if a seat be required). RESOLVED FURTHER, that the signature of any officer designated above, and the seal of the Company, may be affixed by facsimile to any Power of Attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually affixed. IN WITNESS WHEREOF, OLD REPUBLIC INSURANCE COMPANY has caused these presents to be signed by its proper officer, and its corporate seal to be affixed this __11TH day of JUKE, 2018, �eun OLD REPUBLIC INSURANCE COMPANY AsstBLwom Secs, ,eau t i' SEAL ) STATE OF WISCONSIN, COUNTY OF WAUKESHA - SS Vice President On this 11TH day of JUNE, _2018 _ personally came before me, ALAN PAVLIC and JANE E CHERNEY to me known to be the individuals and officers of the OLD REPUBLIC INSURANCE COMPANY who ex_ecuted the above instrument, and they each acknowledged the execution of the same, and being by me duly sworn, did severally depose and say; that they are said officers of the corporation aforesaid, and that the seal affixed to the above instrument is the seal of the corporation, and that said corporate seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority of the board of directors of said organization. s Notary Public My commission expires: 9 / 2 8 / 18 CERTIFICATE (Expiration of notary commission does not invalidate this Instrument) I, the undersigned, assistant secretary of the OLD REPUBLIC INSURANCE COMPANY, a Pennsylvania corporation, CERTIFY that the foregoing and attached Power of Attorney remains in full force and has not been revoked; and furthermore, that the Resolutions of the board of directors set forth in the Power of Attorney, are now in force. 45-5314 City Signed and sesled:at the Ci of Brookfield, WI 9 t is w^ . �4YdV,�IdUIXNM'�� this day of /� , 1316 COUNTY -CITY BUILDING 227 W. JEFFF:C SON Bouil',V RD Sou rrr BEND, 1NDIANA. 46601-1830 Date: May 1, 2019 1865 PHONE:: 574/235-9251 FAX 574/ 235 9171 "1 DD 574/ 235-5567 C1TY OF SC111,1`1i BEND P11TE B1J`1'TIGIEG, MAYOR BOARD OF PUBLIC WORKS 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: 5"// 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 MIST also be included with your bid package upon submittal. THIS ADDENDUM MAY AFFECT YOUR BID. Notes: The attached documents are hereby added to the Specifications and Contract Documents and become a part of herein. Company: Wr% Authorized Signature: Date: -V-/J-..- - _._. ._.. ........... .................. Version 4/2/2015 CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK 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 Contractor Name: Concrc 5e.rUice_5 Zat G . 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 315' 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 -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. (ii) By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided, and may also conduct random inquiries of my current and prior customers. The City reserved the right to utilize all information provided in this submission and all information obtained in inquiries or requests to determine if a bidder is responsive and responsible. Additionally, I acknowledge that all information provided to the City shall be regarded as public records. (iii) /1 By checking this box, I hereby acknowledge that copies of all Applicable apprenticeship certificates or standards for training programs applicable to the work performed on the project may be requested at any time and shall be furnished upon request. (iv) By checking this box, I hereby acknowledge and ensure that I and all sub- contractors, from whom I have accepted a bid and/or intend to hire to perform work on the public work project, are properly licensed. Furthermore, I acknowledge my understanding that it is my responsibility to ensure that all sub -contractors have the necessary licenses to undertake the work called for in this bid. If a sub- contractor loses their license at any point, it is the responsibility of that sub- contractor to notify the City. (b) Attachments (i) X Indiana Secretary of State's on-line records (ie. Business verification) dated within sixty (60) days of the submission of said document showing that business is in existence, current with the Indiana Secretary of State's Business Entity Report, and eligible for a certificate of good standing. (Not applicable to individuals, sole proprietors or partnerships). (ii)L List identifying all former business names. (iii) air°p`., Any determinations by a court or governmental agency any violations of federal state, or local laws including, but not limited to, violations of contracting or antitrust laws, tax or licensing laws, environmental laws, Occupational Safety and Health Act (OSHA), or federal Davis -Bacon and related Acts, within the preceding five (5) years. (iv) M 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) 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) X List of projects of similar size and scope of work performed in all areas, including the State of Indiana, within three (3) years prior to the date on which the bid is due. Date: (Swgn e �� 04 (Print Name Here) Sero .5 nG (Name of Company) 71,-,?- Rick ^ o^® S-f. (Address of Company) (City) (State) (Telephone Number) Version 7/20/2018 General Conditions - 10 State of Indiana Office of the Secretary of State Certified Copies To Whom These Presents Come, Greeting: I, CONNIE LAWSON, Secretary of State of Indiana, do hereby certify that I am, by virtue of the laws of the State of Indiana, the custodian of the corporate records and the proper official to execute this certificate. I further certify that this is a true and complete copy of this 2 page document consisting of the following records filed in this office: Certification Date: May 06, 2019 Business Name: PREMIUM CONCRETE SERVICES, INC. Business ID: 2004120100105 P, Transaction Date Filed No of pages ..... w.. ».............. Re o.�..�. m....._.. m..,_ a p 11/05/2018 2 Business Entity Total No. ...... .........�.r. t of pages 2 In Witness Whereof, I have caused to be affixed my signature and the seal of the State of Indiana, at the City of Indianapolis, May 06, 2019 CONNIE LAWSON SECRETARY OF STATE 2004120100105 / 10955519 All certificates should be validated here: https://bsd.sos.in.gov/ValidateCertificate Expires on June 05, 2019. Page 1 Of 3 CertificateID:10955519 BUSINESS ID BUSINESS TYPE BUSINESS NAME TE ENTITY CREATION DAj EFFECTIVE DATE EFFECTIVE TIME ,WGISTERED AGENT TYPE NAME ADDRESS APPROVED AND FILED CONNIE LAWSON INDIANA SECRETARY OF STATE 11/05/2018 12:36 PM ............. 2004120100105 Domestic For -Profit Corporation PREMIUM CONCRETE SERVICES, INC. 11/24/2004 Indiana 712 RICHMOND ST, ELKHART, IN, 46516, USA 2018/2019 11/05/2018 10:23 AM Individual MAX A. YEAKEY 712 Richmond Street, Elkhart, IN, 46516, USA max@premiumconcretconline.com I acknowledge that the Service of Process email provided above is the email address at which electronic service of process may be accepted and is publicly viewable. Page 2 Of 3 CertificateID: 1095.5519. 11 - ONION President APPROVED AND FILED CONNIE LAWSON INDIANA SECRETARY OF STATE NAME Becky L. Yeakey ADDRESS 712 Richmond Street, Elkhart, IN, 46516, USA Vice President NAME Max A. Yeakey ADDRESS 712 Richmond Street, Elkhart, IN, 46516, USA THE SIGNATOR(S) REPRESENTS THAT THE REGISTERED AGENT NAMED IN THE APPLICATION HAS CONSENTED TO THE APPOINTMENT OF REGISTERED AGENT. IN WITNESS WHEREOF, THE UNDERSIGNED HEREBY VERIFIES, SUBJECT TO THE PENALTIES OF PERJURY, THAT THE STATEMENTS CONTAINED HEREIN ARE TRUE, THIS DAY November 5, 2018. SIGNATURE /s/ Matthew A. Yeakey Legal Representative Business ID: 2004120100105 Filing No.: 8071563 Page 3 Of 3 CertificateID:10955519.. -- Business Name: PREMIUM CONCRETE SERVICES, INC. Entity Type: Domestic For -Profit Corporation Creation Date: 11/24/2004 Principal Office Address: 712 RICHMOND ST, ELKHART, IN, 46516, USA Jurisdiction of Formation: Indiana Title Name President Becky L. Yeakey Vice President Max A. Yeakey BUSINESS INFORMATION CONNIE LAWSON INDIANA SECRETARY OF STATE 05/06/2019 09:41 AM Business ID: 2004120100105 Business Status: Active Inactive Date: Expiration Date: Perpetual Business Entity Report Due 11/30/2020 Date: Years Due: Address 712 Richmond Street, Elkhart, IN, 46516, USA 712 Richmond Street, Elkhart, IN, 46516, USA Name Title Address MAX A. YEAKEY Incorporator 1737 CRABTREE LANE, ELKHART, IN, 46514, USA Type: Individual Name: MAX A. YEAKEY Address: 712 Richmond Street, Elkhart, IN, 46516, USA Premium Concrete Services, Inc 712 Richmond Street Elkhart, IN 46516 574-264-0196 fax 574-266-5392 05/06/2019 To Whom it may concern, Premium Concrete Services, Inc. currently employs 35 people of which 4 are field supervisors, 10 concrete finishers, 11 laborers and 3 heavy equipment operators. We are signatory to the Cement Masons, Laborers and Operators local unions through which extra employees can be pulled from when needed. �ax Yeakey VP Premium Concrete Services, Inc 712 Richmond Street Elkhart, IN 46516 574-264-0196 fax 574-266-5392 05/07/2019 To Whom it may concern, Premium Concrete Services, Inc. has all employees properly classified under all applicable state and federal laws and local ordinances, as well as any independent contractors that would potentially be called upon to assist in completing a job. ��e Max Yea key VP Program Registration and U.S. Department of Labor Apprenticeship Agreement Employment and Training Administration Office of Apprenticeship .._ does; not constitrtte r Title 29, T � - ..0 f�EDfwTfATtt�W'-�;aEGTNOf"d P(I � OMB No 1205 0223 Expires„ 1131/202 Warning:This agrrerntant of ti � a certification rxnde .. Title 29 Code of Federal Regulations (CFR) Part 29 sets forth labor standards to Ci R, Part ra for tine employment of file apprentice on Federally financed or safeguard the welfare of essr ated construction projects, 8ss, Current cafrBifiratiorls must be obtainet9 apprentices and extend the application of such standards from the Office of Apprehticesitip (fOA) or the recognized State by prescribing policies and procedures concerning registration. This collection Apprenticeship Agency shown Below. (lt6m 24) instrument has two sections, one for program sponsor's Information (Section 1) and one for apprentice's information (Section 111). 1 (Last, Name „ Fars MPt ETBD f3"f AS 1FE fi rl fIOT' TO ,PDNSpR. PART SHC}DefinONLitions , reverse)D ODD RY AS PREC�TtCB' t, Middle) and Address µµµ Veteran Status .�_ .. MURRY, ROOSEVELT 4. a. Ethnic Group faarticipant did not self-€den1y Non Veteran 4008 ST. ANDREWS C1R APT 2D b Race MISHAWAKA. IN. 46545 _........ _.. _..... ........................ 2. Date of Birth (Mo., Day, Yr.) 3/26/1980 B. Education Level _ ........_. _.._......... Black or African American GFa 3. Sex (Mark one) Male 7a. Employment Status New Employee 76 Careern anverse) None „Connection Pirns�tkuctions o.. .. ui a4pprenuce Data 9. Signature of ParenilCsua — -�r _..._.� rdian of minor) Data PARrs:spousom EXCEPT FOR ITEMS 8, 7, 8,10a. -10C, REMAIN[ I. Sponsor Program No, IN010950002 Sponsor Name and Address (No. Street, City, County, State, Zip Cade) Plasterers & Cement Masons #692 J.A.T.C, 220 N. FULTON STREET INDIANAPOLIS, IN, 46202 F ITEM REPOf RJI LAATEt3 FRom PR GRAM REGISTRATION. .. _. t'a 0ccupatton (The work processes listed in �� O on Code: 0075 V1 Interim V he standards are eaa1 of this agreement). . Credentials Only applicable to Part s, CEMENT MASON 3,b. and 3.c. JAOpcnc elation Training 4, Term (Hrs.) f„ Prohanonary Perind (Hrs.) T€me-Based 5600 1000 iT-rExperience Preµ a (Hrs.} g 8. Date Apprenticeship f ous 160015 � Remain€ W Begins P (Hrs. n ate ...`.�...�..__ 4000 9a. Related Instruction ppr®ntice —W ag a s`—ior Re. w d�^W.n fInstruction ,elated Traaig Instruction _Source 432 hours TotalT1_N1_-__11_ CEMENT LOCAL 692 JATC —.. 1. Wages: jInstructions on reverse) 10a. Pre-Apprenticeship Hourly Wage $24.20 pp ntice's Ent Hourly 4.20 10e. Journeyworker's Hourly Wage $38.78 10d. Term IJ . m _......,_ _..... 5600 800800 800 800 5600 90e, e ffafe ...�..—.....0 800 800 � .,....... ...—.. _ . fAfag_.�._ -_ m.,.._._ e__ .....�.,.. 0 Percent 60% 75% 80 70% %a 85% 90% 95% 100 /o Hourly _.._.... 11, Siglarttt e of afrcarfsrr l raiares rdtative(s) YDate Signed �.. 11, Name and Address of Sponsor Designee to Receive Complaints ✓ (if applicable) PATRIiCK HANSEN 125 gnature f Sponsors Re resentahve��._m_. 220 N. FUL'rON STREET p O Date Signed INDIANAPOLIS, IN. 46202 ..,..,�,,.......�,.. ,.:,.ur 111 n e:,tar. p r d"KM a raJ't4a ar�1.31'. r+i.S.e'k''....................�.,......_.....,......�.„_.�„..,... ..__..._,.m....'�.�.. .,.. ,.� �. 1. y and Re istratlon Agency an _g g g ncy Address 2. Signature (Registration Agency) Office of Apprenticeship USDOL 9 y) IDate Registered ... oufh ren Bend, IN,, 46628 7900 _ Kathleen Sokolowski 9/15/2015 4. w Identification Numberon on reverse): IN15NO7110 ,ice...... Definiti....._ _..._ u _ ..�.,.....�.-� Page 1 of 3 ETA 671 — Section 11 (November 2014) Program Definitions and/or Instructions: Part A Item 4.a. Definition , Ethnic Group; Hispanic or Latino. A person of Cuban, Mexican, Puerto RIcan, South or Central American, or other Spanish culture or origin, regardless of race, The term. "Spanish origin,,, can be used In addition to "Hispanic or Latino." Rom 4,11b, Definitione, - Race. American Indian or Alaska Native, A person having origins in any of the original peoples of North and South America (including Central America), and who mafnlafnr� tribal affilliatiOn or community attachment. As$an" A person tiaving OrkIns in any of the Original peoples of the Far bast, 8uutheast Asla, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, I<Orea„ Malays ia,Paklstan, the Philippine Islands, Thailand, and Vietnam. Black or African American. A person having origins In any of the black racial groups of Africa, Terms such as "Haitian" or "Negro" can be used in addition to "Black or African American,, Native Hawaiian Or Other Pacific Islander. Aperson having origins in any of the Original peoples, of Hawaii, Guam, Samoa, or other Pacific Islands, White, A person having origins in any of the original peoples of Europe, the Michife East, or North Africa. Item 7b. Instructions: Indicate any career connection (definitions follow). Enter "None" if no career connection applies, Pre-ApfIventictship. A prograrn Qrsel Of Strategies designed to prepare Individuals to enter and succeed in a Registered Apprenticeship program whicil has or have a documented partnerships) with al Registered Apprenticeship program(s), Technical Training School. Graduates trained In an occupation from a technicat training sthoof related to an occupation registered by the Program sponsor and whn fileel the Mininlurn qualifications for Registered Apprenticeship, Military Veteran& Veterans tlIal completed a rofillaly lechrilcal lialning school and/or elect to PallicIpSte In the Building and Consieucilon Trades Helmets to I-fairdhals Program or trained in an Occupation while in the military related to an occupation registered by the program sponsor and who rneet the minimum quallfications for Registered Apprenticeship, Job Corps. Graduates trained in an occupation from a federally funded Job Corps center rotated to an occupation registered by the program 5110111sor' and who meet the olifilnium qualifications for Registered Apprenificeship, YoulliBuild, Graduates (ralned in an occupation trorn a federally funded . YoUfliBuild program related to an occupation registered by the sponsor and who meet the minimurn qualifications for Registered HUDISTEP"UP, N)PIlcanits who skxcessfiAy POilidpaled in the g -d Apprenticeship. program and received an aPPIenficeshIp experience which meet 6, S. 01apa rinient off tousing and U riba n Developil, lent Ste p.,Up a ,,, reer center participants referred to Me Registered Apprenticeship Program 011dior appfrnilce(s) Career Center Referral. Indudesv 5 OKA. minfinurtl qL1aliF1c80Oos for Registered ApIplenliceship, Itiat recelve workforce syster, funded services that suppoo their parficipallan in a Registered Apprenticeship program. This may lorfUde file Use of Indfv1dual lra$nint 0 accounts andlor on 4he-jol) training reimbursements S0100140-Registered Apprenticeship. Program designed to a school allow hlDh s h youthages 16 - 17 to enter a Registered Apprenticeship program and continue after graduation with full credit given for the high SdIO01 portion, Part B He- 2-b.1, Interim Credentials. rjased On program standards Mai Utilize the competency -based or hybrid training approach, anti, upon request of the f)(OgrOM sponsor, the credentials are issued as certificates by Ii* Registration Agency. Interlm credentials Provide Certification of COrnipelenCy attainment by an zipprenfice, Item 3. Occupation Training Approach, The program sponsor decides vdAch Of lhe three trafrilrig methods to use in 1110 program as follows: 3-a. Time -Based Training, Approach - appter'lice required to complete a specific number of tiours of on-the-job learning (OJL) and related training instruction (RTI), 3.b. Competency-Based'i-Paining Approsoll - apprentice required to demonstrate competency In defined subject areas and does not require any specific hours of: OX or R1 I; or 3.c, 1 lybrid-Tiaining Approach - apprenttce required to coniptele a rnlnirrrum number of OJIL and RTI hours and demonstrate competency In the defined Subject areas, Item 4. Term (Hm,, M'os., Yrs,), Based on the program sponsors training approach. See Part 13, Item 4. Available in the terms of the Apprenticeship Standards. Item S. Probationary Period (Hrs. Mos., Yrs.) Probation period cannot exceed 25 percent of the length of the program or one year, whichever is shorlec Item 7. TOM Remajuinq (tirs., Kos., Yrs,)Under Pad G, lle.m 6Credit for PreviousExperleor:e Mos., Yrs,) is determined by the program sponsor. I'lle I errn Remaining (His., Mos,, Yrs,), In Pail B, item 7., for lhe appremilre to COMPICte the apprenticeship is based an the yhe term remainIN is availtable In the berms of the Apprenticeship Standards, Item 110. Wage Instructions: 10a. sponsor enters the IndivIdual's hourly wage in the quarter prior to becoming an apprentice. 10b. ApprentlLe's enlry hourly vua ge (hourly dollar amount paid). sponsor enters this i3wentloes entry hourly wage, loc. JOUMeYwOfIker's wage, sponsor enters wage per hour„ 1 Od. Terni. sponsor enters it, each box III,() apprentice Schedule of pay for each advancement Period based on the program sponsor's Training approach, See Part SHein 3., and is avriffabte in the terms of the AppreilticeshIp Standards. Percent or dollar arnouni: sporlsormatks one, Note., loc. 4 the employer is signatory to a, collective bargaining agreement, ills journeyworkei's wage rate In die appilcable collective bargaining agreement is, Idenljfled. Apprenticeship program sponsors not covered by a col dive bargaining a9f0emerit must identify a mjnorfunl 1 Od. Jo urneyworker's hourly wage rates 111 a t will be I he basis for file Prq FOSSI'Ve Wage schedule Heel Ifledin dens, I Oe,of this sgroor),0111 . "h* employer agrees 10 Pay the hourly wage rate identified In lhis section to 1110 80fenfi" each period of the apprenticeship based On the; successful completion of the Inaining apprimch and related Ins1rucilons outlne(j in the Apprenficesnip Standards, The period may he expressed in hours, Months, or years. I 0e, The wage safes are eNI)ressedeither as a Porcent Of in CIOJW8, and cents of the fourneyworker's wage depending on the industry. Page 2 of 3 ETA 671 — section I I (November 2014) �CR A�PPTJ Mos,, Yrs, 10010 His, 1000 Hirs. PuLdi 1000 Hies, P-OffliQA-4 Lo-rLa _dS EftiU % 65 so 65 1000 HfS. 1000 Hirs, 1000 Hirs. 70 80 go E x- 9 111-r-m jagdoAl egrioci Hr-s', Mos, Yts, 6 MO& 6 Mos, PRLLOIL-1 Egdod 4 6 Mos, 6 Mos, Le-r'20-4 EY-IL-A-6 EIrIA-7 fSe—H,4.0 so 55 610 615 6 Mos, 6 Mos. 6 Mos. 6 Mos. 70 76 80 90 Item 13. Identities the individual or entity responsible for receiving complaints (Code of Federal Regulations, CFR, Title 29 part 29.7(k)), Part C. Item 4, Opfirifflon, The Registered Apprenticeship Partners information Data System (RAPOS) encrypts the apprentice's social security number and gfencrzte$ a unique identification nuilliber to identify the apprentice. It replaces the social security number to protect the apprentire's, privacy, 'The subfnGssion of your accial$OcalitY nurnhOF IS requested, The appmnuce's social scosrily n1trabet vall only be used to venly then alarm fice% pefludsof eMPICYMOnt aild 'rages ter Pt4fP0sas Of cafll4ing with lho Office of Management and Budget related to c0raftlutl measures of Ole Faderalt iub babdrig and arnfArlyravnt lar",ramz low fneasuring parfornafarvncylustreornaans and for puq)000s of Ine Governmujt PvdcnmaQe and Ras,ufts Act, 'The Office Of Apprenflcaship cult! use Wa;e records throw0l) theta Wage ReordhWthSystem d neads toapprentice's s,inj sec flurribe, to match this ounlber ogallsit the ornployer*, wage rocords. Also, the apprentice,$ social sacknily nfjrnho� Mill he used appropriate, for putponos of the Davi's Bacon Act at 193 1, as aplended, The US. 00�adn%nl of Labor. Wage as O.S. Code TI1O 40, $00IOns 2760 to 276,a-?, and Tille 29 CFR 5, to verify and Certify 10 your oci�uprflianaj closslfloMoo, Failure 11 four D"I'dSIon, u"t you are a MUWOfad OPPren0co to anauro ftrat the employov is cornplying VAh flW geograpfifu Prevailing wage of 0 disclose Your Svdal SecUritV nurnWr on this form VAl not arfact your right to te fo&terad aS an aplaanjics. Civil and tdafoot to 0viBiOns of ti'm PrIvacy'Act apply to any onlavAul d6dorure of year social S"uTily llumber, WhIch is fNola4iltod the 000011"n and Maintenance sit Ihar dala On ETA-671, APPre-nfice Re&llalicn - Sgchon 1111 Form l[ authorized under 1110, National ApisTengcol3hlp Ael, 29 U,S,C. 50, 4ad CFR 291311029A The drta is uaed for opprentico,51110 1)"JUIEwil stalislIC01 purposes and is the PrIvrscyAdor 1974 (6 U.S.G, Ina 00110d, DOUEMA. Registered Apprenwestnp pannam information 10"Iragement Data Systern (RACIMS),Il ihjf� (J�& Dt'itarlmoni of Labor, offloa of ' s ,lent be discinsed 1,13A Slate Apprenticaship Agenicy to detanitine an D"essmant of skill Aplitenticeship,, Dato may law, needs and program ane' in COnnerj'an voltla fede'el fNgallOn Or When require4 by POMP$ �JrP not required to respond to this cdlecUmp of inibirriatian Mim's it displays a currently vOld OMB COntrOf 'Willbor. PulAir reponing burden for fllig cog"ton or intoirviation is eminnaktd, to numage five Minutes Pal' resrWilse, including ft, latio for rovilowing insiluclions, saarching, exis,fing, data ��ojjrces, 98glering au 0,11lial,lnij the data neoded, nrld rorliplenno aril re'vlawiflS lire c011aclkin or infafmalion, 7110 Obligation to ragpond Is requIfed to obtain 01 retain benefilf, undw 29 USC 5D. Send conlwents regardikg) 01k, bunion or anyoillar aspect GI this collection Of InfOnnalion inclisj sug9e$9oas for pod19 t Apprenticeship, 200 ConsfituUon Avenue, N,W., Rcovi N-5311, WaStlington, 0,C, 20210 WaParwork Reduclbfw�) Profort 12burdorn la 05-0023) office of Page 3 of 3 ETA 671 - Section 11 (November 2014) U.S. DEPARTMENT OF LABOR -- 0IFFICE 01" APPRE NT1CFSjjjP A.PPRENT1cr&,MiP C'EWIfFICATION Premium Concrete Services 712 Richmond St. Elkhart, IN 46516 J'he fbIlowing individuals are appreritices registered with the U.S. Dej)artniew oft,abor, Office of Apprenticeship, under the sjr,)oiisorship of 1,)rogram IN010950002 - Plasterers & Cement Masons 4692 .).A,T.C_ Plasterers & Cement Masons #692 J.A.T.C, 9200 Louisiana Street Merrillville, IN 46410 A01 SIN tic e Apprentice Occupation Apprenticeship Date Name Cancelled Cement MURRAY, Mason - 2018 IN15NO71105 **-6606 ROOSEVELT (007.5 VI) 8/1/2015 Time -Based Certified by the U.S. Department of Labor Date Issued: 12/13/2018 ****VOID 90 DAYS FROM ISSUE DATE**** Date 'Coxnt�leted Pro -1 -n r "fp L Q -CI � "'�' fab�affolq -lid Apprerniceshfp I'k9re-ement OMG�e ofAppFentfcastilp .APIPPW�4171r-z- Wamfngina� vijra"nnnt do ei not wmirkIUT.6o a mi�W&Mlon wmdorlj'fik�, W-R, PaC, 6 for M 6 emip@oymauk On Fo6wily M-411ced aesi'vDa-d r-ansfruejoa Projeo-&- (-'ulront wriffiva"HDOS anmt be obfahl from ffzf-% Unce- Of '4'prerrhk'whd,� (DA-) or ffi's rmmsnted wh Name (Last, FIrst, Wldk--) apt.1 AdriFf?SS 'Si�. 'wi 7- (No., ,Street, City, State, 7jp Gode, k Y. DatL, of Hirdi (Mo., Day, Yr) a Sax (Mark one) of Labor Department cmployment and -Eral iing Admirtsfrarion TF 1206-0, 2; - ?3 -Illsprogioni, sponsor and appP4T&-F" agres to tha tw-jrnz of tta Appirpritr as part of 'Hu Agraarnent Tffiarponuor loll not crj,wr jjiftinp in Me selertirm and Wining o-f the appienUm rn ar-cofdama v&h -the- Fqu Opportunibr -Siandardo- hi ITIP 29 GFR Fart 30, and E-y-arxifiva Onfer 'I'l-246, I-r al Mu lunk"fraffun aurmw'v. In Tifln'2P- (PR- Pm4 xs -Answer Both A and B (ifoluntan)) Qv�fmffcns on reverse) a- Ethnic soup ip (Maria on,) flibparfiG or-C.a.ffno t�tl Hispanic. or Ltatio 35. vpfpMIfl 'St-alus 4Maric One) F --duantion Level (Uarkorja) FT8khrT—'4eo T-- 0 to 'I 2-h� grade, L I Amm-cari-Indim or Alaska native Asian Cgrl F31ack ctrAticar, 1'11adwa Ha-mouian OF othf-ar @-RI High 30hool Gmduaye or pnala Gfafttc�r Me 1.1 POSt �Sf--'-Qndary or Tecbrrfml DA110 FJ . . . . . . . . ............... 7A. -Empfaymenf Status a4;Aq- orle) 7b, Careerrnnnection (U2rk one fIns.truc6o.4 nn revemn) 15e�,WIP Ej Pre-Appi-cinficsship f-I IffitaTyVeferano J-1,fribcorps _L[YOWIBUIld [] HAMWEr-LUP E Gafeer CenteT Rmiarraf -- ----- - - -------------- . . . . .... . ............. ........... .... ........ . . . IT t4 Ap f4,, U V nature uJf'Par-anf(GuaFdPau ffrfl[aor) Data fI� �SVOM§dk�.- F�"Cl`w FOR ri-E, 'S 6, 7, 9, Ilra� - I -- ---------- 1. Sponsor Prograu .4 0 1 S'I—() 0 Sparmur Nam and Addrese: (No- Street GIW, Gomyt, Stele, i'ip CWt;) J T C. 4 31 O'z ffbik"P54-0-PW-A RAM 'Xhf.)N !a 0,cupaffort fffia mik processes r1sted in 2h 0 x p, ion. Code-- 61, 61 he sfardurilsu-- part ofthis, agreement)- 2b. 1 . Inteft Credentials Only a,pplicable fo Part D, 3-b- Enter, Occuqodion land 3.. (A6ark on eali ST R v ef 4 1) A) LI Y,s U V. f4� Occupailon Trainvirj­ �a -j period one) (FIrs., Mrs-, Ym,) (lim, P&os., Yrs.) 14 q Y I 36. Gumpotomc t&S 3m I �ybrjd Ramahing 4j,)t6XI;(w �VMO-47 'q." ij?" B. GrFditfur P03-mous 7- Term Yr, Expe6enm (firs., Mos., Im, mm' yhs') IS, , ............ . . ... ... .. .. ...... ....... . .... (Number�of vsPerYbar) Fisk, id jQl� �tit Be Paid - — ---------------- ---- -- '4a I I Wages: (Instructions on ramesa) 1-1 0% Pre -Apprenticeship Hour{ Wage I Ob. Apprentice's Entry Hou dy Wage 10 u� J a w - n ey wo rb C-- go ur Iv W; ag s $ . ........... . 2 3 4 5 a 9 10 IPII ks.' LT MOD, or Ely f0e. 'Nage ILR'rim / i -� Y&ik % [Alor $ III 1 -1, SIgnatwi-- of Sponsor's 1Z Ski nature. oflSpons&,q Repre-oontafive(s) 904 . ........... . Date StgrIE30 Date 21gne4 13. Name andl'Wdress of SponsarDesIgnea to Receive Can, plaintss - (11"'applicab &tM<I),YpJ 1171124 I. %1Frqffun Agenc,�y uc[Address Signalurs F18"g]"tmed t. ... . ........ . ... 4. ApprvliUf,rr rdenliffuiAmi Munfier (Definition on mmisel: PREMIUM CONCRETE 712 RICHMOND ST_ Y 60, e4 o 1111 �I y ff.. May 9, 2019 To Whom It May Concern: This is a letter to inform you that Premium Concrete Services, Inc. is a contractor member of the Building & Construction Resource Center Inc. drug testing program. They are a contributing client and meet all of the industry standards set by the Business Roundtable of Northwest Indiana and the Department of Transportation. Due to confidentiality, we are not authorized to submit any current status of Premium Concrete Services, Inc. employee's drug tests individually. However, we will assist you in doing audits of Premium Concrete Services, Inc.'s personnel working in your facility by simply providing BCRC with a list of names and last four social security numbers. If needed, we will confirm the availability of the entire group given to us, which will also confirm that Premium Concrete Services, Inc. is performing the screening of their employees. Employees are subject to the terms of the BCRC Drug Testing Policy which meets or exceeds the requirements of IC 36-1-12-24. I hope this meets with your requirements. If you have any questions or need more information regarding Premium Concrete Services, Inc.'s employees' statuses please do not hesitate to contact me at (219) 764-9500. Sincerely, AiLc� 4qAvek Laticia Roach Executive Director Well-BeingPromo[ing the Safety and Building & Construction Rei 0764-9505 Southport6050 / 4 Premium Concrete Services, Inc 712 Richmond Street Elkhart, IN 46516 574-264-0196 fax 574-266-5392 05/09/2019 To Whom it may concern, Premium Concrete Services, Inc. has no federal, state or local tax delinquencies owed to any of the fore mentioned taxing bodies, nor has owed any in the past three years. gym_ Max Yea key VP N r 0 r D N z oro s C < oro a o N o A w p O Q n O N m m D_ S m m v ro * r) to m -n m to m to 0 c � c S N G Gl 3 0) 3 N W `< Y W W 7 N 7 7 C a a n n D z a v 0 0 .2. o In O m rD C m � = ro n W rt rt m o_ M n n n m Ln fD W W C N 00 N 00 `ul 01 01 vi V r cn w N In V Fn V A G ON lD r In O V M Q) M ni M O 9 a E3 M rt 0 0 o o o a 1 n n C C p _rD 1 D 3 0o '6 < < M to fD v, O S M M M m (o m d drD (D n O v� v�i 0) 0) 0) 0) c rr 0 o D D D D rA O 0 n O 3 0 M. O D O rt G_ m n� (gym f7 O 9 V r m m v O m N N O I' 00 m m K C n 0 z n z m m m mm cn k / 0 # f \ / \ w E o D® & 2 E o 7 e ru A a); a \ _ \ \ 7 \0 .. . \ § 0 ƒ. \ \ \ \ \ r E I @ o $ § a k rD 0 / \ / f \ % _ q w ) G n = o k ] ƒ k \ _ _ _ _ . to \ N � � � § A. � PO N g Ln w Ln g § 2 / QJ 0 \ R � ƒ 2 c o \ ( 7 \ / rD 2 ° \ / cu I a m — — 7 z } § / 9 2 G rL M ` ƒ e \ / \ \ � � & n \ ( / ] � = § / § 0rD m k ƒ 0000 O 0000 z 0000 z 0000 (D 0000 00 m A p r p rn nvi O 0000 ul L s on`n ' O_ W z n O v � 3 000 V 7 C N N A C r CL M 00 U'1 ry (n O Ol O 7 O O n n! O 7 m Q° O a d N ((DD ni s v w 0t O S O O (D o� (D O d O_ K _.. z.. Z co v v a C 0 _ o O m O 77 7 _ n o i Dl o n 0 O (/) (D N Ln O S '-r m z n m O G 0 qjl- 4A. N V`000 OWO A O W A V ON1 V 000 00 W W O A O O N A O O O c m D mo X Q o c n rr O -v -w �N 0. to ...- = Q rr m n �. O or VCi 03i w rr tOn O) 7 n O 3 a O_ p) (gyp O O of O< c n n 0y a O 0 o n v ::�CL(D (D- r 00 ^ F v D O 3 O m - m rD O. oo n n O ? O W v a a v O_ < D� 3 c rr n �_ 3 S (D O m o fD 3 F o S 7 m d (D m m K d n D. m m n :3 Q 00 iD a n n m n c :3. a Q c r r n 0 go a a v n �r C n m Q° m s ((D ao Premium Concrete Services, Inc. 712 Richmond Street Elkhart, IN 46516 (574) 264-0196 SECTION I PLAN AND EQUIPMENT QUESTIONAIRE 1) PUBLIC WORKS PROJECTS COMPLETED IN PAST YEAR: CONTRACT COMPLETION.._.. .........................OWNER�...�..........-... AMOUNT DATE $ 307,372.75 CDBG _ 12/31/18 CITY OF MISHAWAKA $ 267,744.21 WAYNE ST� 6/15/18 CITY OF SOUTH BEND .$••338,615.41 �.� .....SAFE ROUTES TO SCH00.�....�.�....�.�.�.�..9/15/.1.8...........�..w...INDOTw ................................ ...... 107,.8_...m...-m.m._�_�SOUTH�SIDEW��...m.......��....�� $ 98.5 ............. ALK/A ...11/26/................... 18 ...........ww.....................................w_................................................... CITY OF ELKHART 2) PUBLIC WORKS PROJECTS IN PROGRESS: .�... CONTRACT ...................._..................................................................................... .................................._........_.._...._._._._._.�........._........_.....�_... COMPLETION OWNER AMOUNT DATE $ 99,300.00 NORTH SIDEWALK/ADA 7/31/19 CITY OF ELKHART $ 161,510.00 TRAFFIC /CURB RAMPS 7/31/19 INDOT 3) HAVE NEVER FAILED TO COMPLETE ANY WORK THAT WAS AWARDED TO US. 4) REFERENCES: a. NISOURCE — MR. LUKE BRADLEY —1039 PENNSYLVANIA AVE SOUTH BEND, IN 46601 b. LOZIER MANUFACTURING —MR. KEN MURR-402 N MAIN MIDDLEBURY, IN 46540 Premium Concrete Services, Inc. 712 Richmond Street Elkhart, IN 46516 (574) 264-0196 SECTION II PLAN AND EQUIPMENT QUESTIONAIRE 1) Project No. 119-004 2019 Curb & Sidewalk Construction - Schedule: After given the notice to proceed Premium Concrete Services, Inc. will contact Indiana 811 to locate all utility lines within construction limits. Layout and staking of site will be next. Then removals, excavation, grading & subgrade will begin for concrete work. After excavation and grading phases are complete, concrete work will commence. Crews of 4-6 workers will install. Project with be completed on schedule. 2) a) TCS Inc. — 1810 W. Pacific Ave. Knox, IN 46534 — Traffic Maintenance, Signs and Thermoplastic Lines. b) Acorn Landscaping — 3680 W Sample St South Bend, IN 46619 — Top Soil and Sodding. c) Kachur Tree Service, LLC- 316 Fulkerson Rd Niles, MI 49210- Tree Removal. d) Walsh & Kelly Inc. — 24358 IN-23 South Bend, IN 46614 — Asphalt Paving. e) Ritschard Brothers, Inc. —1204 W. Sample St. South Bend, IN 46619 — Removals f) KC Tree, Inc — 8913 East US Hwy 20 New Carlisle, IN 46552 — Tree Removal Premium Concrete Services, Inc. Does not require bonding for its subcontractors 3) Will supply list of subcontractors soon after award of project. 4) Equipment use for project: Bobcat, Mini Excavator, Excavator, Compactor, Roller, Walk -behind Saw, Cut-off Saw, Vibra Strike, Dump Truck. Current plan is to used owned equipment, however depending on workload some rental equipment may be necessary. 5) Yes, Premium Concrete Services, Inc. has quotes for all materials in proposal.