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HomeMy WebLinkAboutOpening of Qualifications - RFQ - Qualified Contractors for Lead Hazard Reduction Demonstration Grant - Building Millenium Consultant Construction LLC/ v H INDIANAOLIS --- MAYOR JOB HOOSETT -- •ar, teat January 28, 2019 Building Millennium Consultant Construction, LLC. Attn: Michelle D. Bivens P O Box 20787 Indianapolis, IN 46220 Dear Ms. Bivens: The Office of Minority & Women Business Development has completed its review of your firm's application for certification as a certified Minority Business Enterprise (MBE) & Women Business Enterprise(WBE). Your company is hereby certified with the City of Indianapolis in the Seswice trade specializing in Lead Abatement Contractor; Lead Consulting Services; Residential Rehabilitation Services. This certification is issued pursuant to the City's Minority & Women Business Utilization Plan, part B. Your certification is valid until January 31, 2022 and is subject to revocation if: (1) changes in ownership; managerial or operational control causes your firm to no longer qualify for the City's M/W/V/DOBE Program; or (2) if just cause is determined through established investigative procedures. M/W/V/DOBE firms must inform OMWBD, in the form of an affidavit, of any changes affecting the ability of the Firm or its owners to meet the guidelines of the City's Utilization Plan with regards to ownership, control or the other certification requirements of the City Minority & Women Business Utilization Plan, part B. (Affidavits must be received within thirty (30) days of the change). Additionally, M/W/V/DOBE firms must provide, yearly, to the Office of Minority & Women Business Development a No Change Statement stating that the qualifying owner(s) continue to meet the ownership and control requirements of the City's Utilization Plan. Failure to provide a yearly No Change Statement may jeopardize your certification status. Please ensure that your contact information is accurate and slaws current. Inaccurate information limits our ability to provide outreach business opportunities. This certification is not necessarily accepted by other States or Agencies and does not verify the ability of your firm to perform the types of work you may indicate. Please go to the Purchasing Division's website to update your business at: wwtiw.iald q, L/laurch or call (317) 327-4900 for further instructions. Sincerely, C shad Beg Senior Manager M/W/V/DOBE Certification Program cc: dr Phone: 317.327.5262 1260 City County Building Fax: 317.327.4482 200 East Washington Street Indianapolis, Indiana 46204 www.ind oy (Wmwg� www 4pw& 4994 t7i VY '4.o "011wal wolPm tT "I'll 'O+MO 4momb, #M�& U) 0 t-,4, cu cn C: 0 E C: a NO 0 N 06 T- 2�1 cu =3 LL CL x M Q) L) c ca =3 to 0 M -a W 0 cu 0 (D Rf ML m 21 0 _0 m La) cli M > m Q) N State of Indiana Office of the Secretary of State CERTIFICATE OF EXISTENCE 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 records of this office disclose that BUILDING MILLENIUM CONSULTANT CONSTRUCTION LLC duly filed the requisite documents to commence,business activities under the laws of t��e State of Indiana on February 26, 200 ; and was in existence or authorized to transact business in the State of Indiana on April 26, 2019. I further certify this Domestic Limited Liability Company has filed its most recent report required by Indiana law with the Secretary of State, or is not yet required to #ile such report, and -that no notice of withdrawal, dissolution, or expiration has been filed or taken place. All fees, taxes, interest, and penalties owed to Indiana by the domestic or foreign entity and collected by the Secretary of State have been paid. r M In Witness Whereof, I have caused to be affixed my signature and the seal of the State of Indiana, at the City of Indianapolis, April 26, 2019 CONNIE LAWSON SECRETARY OF STATE 2008022700231 / 2019958100 All certificates should be validated here: https://bsd.sos.in.gov/ValidateCertificate Expires on May 26, 2019. .q f W .$c DEV ELOPMEN7 BUILDING MILLENNIUM Consultant Construction LLC toa¢y o1 Indianapolis Departwraenl, of at.rs Neighborhood Services MICHELLE BIVENS License Type: Agent License Number: C8300401 Company Name: BUILDING MILLENNIUM CONSULTANT CONSTRUCTION LLC Company License Number: C8300400 Company License Expiration: 12/31/2020 Signature: r- City of Indianapolis .Department of tiu,siness ano Neighborhood Services License Type: General Contractor License Number: C8300400 BUILDING MILLENNIUM CONSULTANT CONSTRUCTION LLC BUILDING MILLENNIUM CONSULTANT CONSTRUCTION LLC - C8300400 is duly licensed to practice in Marion County as a(n) Corporation until 12/31/2020 unless suspended or revoked by law. Signature m Indiana State Department ofHealth m Indiana State Department of Health MICHELLE D. BIVENS The Designated Representative of: MICHELLE D. BIVENS Building Millennium Lead Project Supervisor License # IND000310 Lead Contractor License # IND001653 Effective: 07/27/2009 Expiration: 07/27/2021 Effective: 01/29/2019 Expiration: 01/29/2022 p Birth Date: Gender: Birth Date: 05/19/1969 Gender: F Height: Eye Color: Height: 5' 4 Eye Color: Brown Weight: Hair Color: Weight: 198 Hair Color: Black Lead Renovator cart. No.: R-R-8865-15-12033 1 ralning Dates: 21202015 - 2r202015 Exam Date: 21202015 Language: EngOsh certification Expires: 220/2020 µ, 5610 Cvxawwfu'KdSVddle Pad Star I IrWimapo ix IN 46224. ; are t:117i 2-4848 Issued to, Michelle Bivens 1502 N Olney St Indianapolis, IN 46201 • Q0 DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 3/18/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). ..PRODUCER: N .CT NAME: McClain -Matthews Insurance r�H+ N 3ti"7 298 750t3 FAX 317-298-75,13. 6329HollisterDrive - MAIL EaIt1. I .Nil° Indianapolis, IN 46224 swooRESs. INSUfiTF%§J,Affgf JRMdG COVw RAGE NAIC 4 INsuRER A : Western Reserve Mutual Casualt INSURED INSURER B: AC Insurance C�snapa'any._____. Building Millennium Consultant INSURER C Construction LLC INSIUR!T D. P.O. Box 20787 INsuRER,. E:I Indianapolis, IN 46220-0787 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, I TYPE OF INSURANCE ... .... .... .. POLICY N,�- .(-. .J, Y EXIT .. ...... _. _..... 94SR AIPDL"5UBR POLICY EFF POLIC LIMITS LrR UMBER MRDD/YYYY MMRDB7IYYYY 's COMMERCIAL GENERAL LIABILITY WCS 1311055076 3/26/2019 3/26/2020 EACH OCCURRENCE $ 1,000,000 ,A � X X bA-MAGETC1 RENTED CLAIMS -MADE OCCUR PFdEMI$ES (IEa cccurrenP;a) $ 50,000 MED EXP (/any one person) $ _ 5,000 � PERSONAL & ADV INJURY $ 1,000,000 I GEN`L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 " 1101ICY �LOPRODUCTS $T�;�2,II0„00�0 - ........_.- ,—....�.,., _. NSS-....... COMM �eyxpyCINGLE VOMIT .� AUTOMOBILE LIABILITY INSS-1041s6316 1/23/2019 1/23/2020 $ 1,000.0 (ca00 ANY AUTO X BODILY INJURY (Per person) $ B ;OWNED I SCHEDULED BODILY INJURY (Per accident} AUTOS ONLY ,AUTOS HIRED NON -OWNED PO Pr1RT'Y DM'dw9AG = AUTOS ONLY ,. AUTOS ONLY ,(Petr,aarpleaer),n . UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE RETENTION $ $ WORKERS COMPENSATION PER AND EMPLOYERS' LIABILITY Y/ .N STATUTE }R ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / A --- - (Mandatory in NH)"" E L. DISEASE - EA EMPLOYEE] $ If yes, describe under -- DESCRIPTION OF OPERATIONS below EL. DISEASE -POLICY LIMIT $ i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) City of South Bend and Saint Joseph County are added as Additional Insured CERTIFICATE IIOLDER CANCELLATION City Of South Bend and Saint Joseph County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 125 S Lafa ete Blvd, Suite 100 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN y ACCORDANCE WITH THE POLICY PROVISIONS. Souh Bend, IN 46601 AUTHORIZED REPRESENTATIVE K a rb P B ".P0-W ©1988-2015 ACORD CORPORATION. All rights reserved, ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Geoffery Dean, Jr. Lead project Supervisor License-# INDOOI 679 Effective: 04/26/20119 Expiration: 04/26/2022 Birth Date: 06/13/1960 Gender: M Height: 6'0 Eye Color: brown Weight: 220 -Hair Color: black All- w, Indiana State Department of Health 100 N. senate Avenue, N855 FIndianapolis, Indiana 46204 $ Lead Project Supervisor Geoffery Dean, Jr. Kristina Box, MDt FACOG Kristina Box, MD, FACOG State Health Conlinissioner Indiana State Department of Health !3 [ tqiO tlD I VA 'I o V n J ; 'f t 1) 1 t Lead Piro Btupe ' to ed #'TNOM11M Effective: 04/2 /2019 Expiration'. 04/25/2022 Birth Date: 04/27/1976 Gender: M Height: 62 Eye Color: blue Weight: 200 Hair Color: multi Indiana State Department of Health 100 N. Senate Avenue, N855 Indianapolis, Indiana 46204 V Lead Project Supervisor 04/25/2022 Eiisha Smith Kristina Box, MD, FACOG Kristina Box, MD, FACOG State Health Commissioner Indiana State Department of Health 5 TA rfl' I 'A [ H 1•I 7 - 18, DATE (MMIDDIYYYY) �"�"" CERTIFICATE OF LIABILITY INSURANCE 3/18/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS.... CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy("es) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME; McClain -Matthews Insurance i^hbwi." 317296 7500 ® """ FAX 317-298-75,11 10 6329 Hollister Drive rtAI°"'O ®® Indianapolis, IN 46224 Ykt}DRES._ INSURED MM Home's Restoration, LLC 1502 N. Olney Street Indianapolis, IN 46201-1458 INSURERISI, AFFORDING COVERAGE INSURER A: Western Reserve Mutual Casualt INSURER C : INSURER D NAIC # COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. . ,,...., . INSR A POLICY NU LIMITS 15 NUMBER M5/27/2018 MID Xdt'suBe¢' X_� COMMERCIALOG GENERAL LIABILITY ... EACH OCCURRENCE .. . OO OOO WCS 1341668410 019 A o _. ,.. _ � CLAIMS �„ OCCUR DAMAGE TO RENTED $ 50,000 -MADE PREMISES (Ea occurrence} .,..... ....... .......... ..,. MED EXP (Any one person) $ 5000 PERSONAL & ADV INJURY $...... 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO LOC PRODUCT' U $ COMP/OP AGO 2, D���� �D .��D OTHER $ AUTOMOBILE LIABILITY tLMMF $ accident), �� ... ANY AUTO BODILY INJURY (Per person) .. OWNED SCHEDULED ( BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS C HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPER iY DAMAGE'$ [Par a cidenl,P.... ... � .... UMBRELLA LIAB C OCCUR 1 EACH OCCURRENCE EXCESS LIAR j CLAIMS -MADE AG GREGATE... 1 IHO RETENTION $ is �._.. ,WORKERS COMPENSATIONPER d) I 1 AND EMPLOYERS` LIABILITY YIN _ STATI ITE _ IL I!Z ! _ ;ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT f $ +OFFICER/MEMBER EXCLUDED? NIA ,(Mandatory in NH) EL DISEASE EA EMPLOYEL,, $ i If yes, describe under -- -- - --- -. .. DISEASE LIMIT 1 DESCRIPTION OF OPERATIONS below E_L POLICY $ I I i r DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION Building Millennium Consultant Construction LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE P.O. BOX 20787 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Indianapolis, IN 46220 AUTHORIZED REPRESENTATIVE Karl P 3 ue o u ©1988-2015 ACORD CORPORATION. All rights reserved . d. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SSTEVEN MARTIN 1502 NORTH OLNEY ST INDIANAPOLIS, IN 46201 State Form 56478 (1-18) Workers Compensation Board of Indiana 4- � 01. Clearance Certificate for Independent Contractors SEAL' Name of Independent Contractor Trade Name of Independent Contractor Specified Trade SSTEVEN MARTIN MM HOMES RESTORATION CONSTRUCTION Address FEIN or SSN Phone 1502 NORTH OLNEY ST xxx-xx-9647 (317) 640-2508 INDIANAPOLIS, IN 46201 E-mail Address Date Issued: Affidavit of Exemption Number MM HOMES RESTORATION 3/25/2019 149504 Is applicant an Indiana resident? YES If not, state of residence: Pursuant provisions of IC 22-3-2-14.5 and/or IC 22-3-7-34.5, Applicant has confirmed the following information in pursuit of the issuance of this Independent Contractor Certificate of Exemption: YES Applicant is an independant contractor, as defined by IC 22-3-6-1(b)(7) and/or IC 22-3-7-9(b)(5). NO Applicant is a sole proprietor as defined by IC 22-3-6-1(b)(4) and IC 22-3-7-9(b)(2) Sole Proprietorship name: Business ID: NO Applicant is in a partnership as defined by IC 22-3-6-1(b)(5) and IC 22-3-7-9(b)(3) Partnership name: Business ID: NO Applicant's independendant contractor business is an LLC, an S corporation, or otherwise incorporated and applicant is an officer of that corporation. NO Applicant has employees, Pursuant to the authority vested in me and in reliance upon the express representations made above, I hereby certify that applicant is entitled to and hereby is declared to be exempted from purchasing worker's compensation insurance coverage for the applicant identified above. Worker's Compensation Board VALID Mary Taivalkoski 3/25/2019 Executive Administrator This certificate expires one (1) year from validation date. State Use Only $ 20.00 Filing Fee Paid DOR Filing Fee $5.00 WCB Filing Fee $15.00 Date Entered: 3/25/2019 Validation Date: 3/25/2019 CerMICAIC of MWIM Tr,%WK_g as Lead Renovator Con. No.: R4-8865-1 9.13118 TrWnbg Dates: 01/2W2019 - 0112612019 ExaMDalle:0112612019 Language:111ng6sh COrtificallOn Expires: 01126/20M lesM -3 $610 Crowkffdsvlfje Fjd, $to. 1500 IWOWpON, IN 4022447V (317) 246-4048 Issued tO: Steven Martin 1502 N. Olney St Indan"s. IN. 46201 FWD u t forTaxpayer Give Form to the daday,Decornnlaee20141Identification I �r O Certification regtieator.Donot i.,0w"p,'N,vvivntottp pr4�wn'Ouxv sand to the IRS. lralrsrug M1^« mso ke vu ........ .. e.... ... ......... �- ...M... w.�.. ,..,U ., ..mm.,� ,�.... �. 46rn 0ni e7 fn0 lranw n plum Irma V!8 gmtilx 1, 9 00W n 0r1u yeunr VKJOW, t&as 0o rd 14ernnn rogtirW an�ad on jhs l ..,e,... i 2 t98Yelldness main 0 dllUaq O !iilliq A-ilio S' h W Wra �,"r r off. 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