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HomeMy WebLinkAboutOpening of Bids - Water Works Utility Service Line Repair Program - Niezgodski Plumbing Inc.When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit. CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON-DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS (Must be completed for all quotes and bids. Please type or print) STATE SS:. ® COUNTY ) The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury that: 1. Contractor has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and 2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency; and 3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investment activities in Iran. a, For purposes of this Certification, "Iran" means the government of Iran and any agency or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from time -to -time. b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor is engaged in investment activities in Iran if either: i. Contractor, its successor or its affiliate, provides goods or services of twenty million dollars ($20,000,000) or more in value in the energy sector of Iran; or ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty million dollars ($20,000,000) or more in credit to another person for forty-five (45) days or more, if that person will (i) use the credit to provides goods and services in Non -Collusion Non -Debarment Affidavit Non Iran Form the energy sector in Iran; and (ii) at the time the financial institution extends credit, is a person identified on list published by the Indiana Department of Administration. 4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the Contractor subsequently learns is an unauthorized alien. Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of Contractor's newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3. Contractor's documentation of enrollment and participation in the E-Verify Program is included and attached as part of this bid/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. Non -Collusion Non -Debarment Affidavit Non Iran Form 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 may result in forfeiture of contractual payments. I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for public works are true and correct. Dated this ,4 fk day of Nor_, 0, ' Subscribed and sworn to before me this U My Commission Expires I L�) ` 2-0 - County of Residenc Non -Collusion Non -Debarment Affidavit Non Iran Form Contrac "dr/Bidder (Firm) Signature of Contractor/ i der or Its Agent _.......®. _....... ...... .. t Printed Name and Titl ASHLAN MACKENNA SMITH Seal Notary Public- State of Indiana St Joseph County 20 2025 My Commission Expires May Niezgodski Plumbing, , Inc. Plumbing and Heating Contractor PO Box 3096 South Bend, IN 46619 Phone: (574) 233-9774 Fax: (574)233-9752 e-mail: Sic ptitn pet, Indiana State License 4PC88701935 Established 1922 November 12, 2019 City of South Bend Board of Public Works, 131h Floor County City Building, Room 1316 South Bend, IN 46601 Attached please find the required documents as requested for the Water Works Utility Service Line Repair Program. Niezgodski Plumbing Inc. has been providing reliable plumbing service in South Bend for 97 years now. In addition we have been performing water service leak repairs and stop box repairs for the City of South Bend since 1972. Our 41h Generation family owned business employs qualified and dedicated employees. From day one, instilled in all of our employees is the ethics of hard work. It is stressed that an attitude of honesty and integrity shall always be prevalent. As representatives of the City of South Bend, during the course of performing Water Works Repairs we realize that our performance serves as a front line view of how South Bend residents judge the delivery of one of the City's most essential services. Safe drinking water available to all city residents with minimal interruption, is of utmost essence for any city's administrative and departmental success. Niezgodski Plumbing Inc., will continue to deliver these services to the City of South Bend and view them as our highest priority. We are fully equipped to handle all Water Works repairs, including every manner of emergency service required. We have all the necessary tools and equipment and they are kept fully maintained. We meet all of the requirements called for in the specifications of the Board of Public Works Request for Proposals regarding the Water Works Utility Service Line Repair Program. In addition we acknowledge that these repairs must be performed in any and all adverse weather conditions. A In addition, Niezgodski Plumbing Inc. shall also be responsible for the preparing and pouring or subcontracting of all sidewalk, driveway and street cuts, according to City specifications. Included please find all required Commercial General Liability Insurance information, Workers Compensation Insurance, required performance bond information and a copy of my Plumbing Contractors License and Corporate Plumbing License. Also included is the signed and notarized Non -Collusion Affidavit, Non -Debarment Affidavit, Employment Eligibility Verification and Non -Discrimination Commitment Form. I sincerely hope to have the opportunity to continue representing the needs of the South Bend City Water Works in every manner necessary, for many future years to come. Please do not hesitate to contact me if there is anything further you may require. r David Niezgodski President, Niezgodski Plumbing Inc. 574-233-9774 niezplum@comcast.net WESTBEND A MUTUAL INSURANCE COMPANY' Date: 06/04/2019 Bond Number: 2413278 DAN BERRY INSURANCE AGENCY INC 54101 IRONWOOD RD SOUTH BEND, IN 46635 PRINCIPAL INFORMATION: Niezgodski Plumbing, Inc. PO Box 3096 South Bend, IN 46619 Billing Address - if blank, see Principal above: Obligee Information: City of South Bend Board of Public Works 227 W Jefferson Blvd South Bend, IN 46601-1830 WB Index: NLF 2413278 0 Bond Eff Date: 07/16/2019 Bond Exp Date: 07/16/2020 THE SILVER LINING' 13020 E BOND EXECUTION REPORT Bond Type: -Generic License & Permit Compliance (including Instant Issue) Work Description: License & Permit Compliance Plumbing Contractor Current Bond Limit: 25,000.00 100.00 $ Bond Premium: $ Previous Bond Limit: $ Premium Change: $ 0.00 THIS IS NOT AN INVOICE MICHIGAN ONLY: This policy is exempt from filing requirements of Section 2236 of the Insurance Code of 1956, 1956 PA 218 and MCL 500.2236. P.O. Box 620976 1 Middleton, W1 53562 1 Plione: (608) 410-3410 1 Fax: (877) 674-2663 1 www.thesilverlining.com �"/WESTBEND A MUTUAL INSURANCE COMPANY" r Bond Number 2413278 License and Permitors+ Not valid for Contract, Performance, Maintenance, Subdivision, Supply or Utility Guarantee Bond. (Valid in the states of Illinois, Indiana, Iowa, Kansas, Kentucky, Michigan, Minnesota, Missouri, Ohio and Wisconsin only) Principal: (Full name and address) Obligee: (Principal's customer) Niez odski Plumbing, Inc. PO Box 3096 South Bend, IN 46619 227 W Jefferson Blvd South Bend, IN 46601-1830 Effective Date: July 16, 2019 Expiration Date: July 16, 2020 PENAL AMOUNT OF BOND: Twenty Five Thousand Dollars Dollars ($ 25,000.00 a lawful money of the United States, to be paid to the said obligee, for which payment well and truly to be made we bind ourselves and our legal representative, jointly and severally. The condition of this obligation is such, that whereas, the principal has been licensed by the Obligee for: Plumbing Contractor NOW, THEREFORE, if said Principal shall faithfully perform all the duties and comply with the laws and ordinances, (including all amendments) pertaining to the license or permit, then this obligation shall be null and void; otherwise to remain in full force unless renewed by continuation certificate. This bond may be terminated at any time by the Surety upon sending notice in writing to the Obligee and to the Principal and at the expiration of thirty-five (35) days from the mailing of notice or as soon thereafter as permitted by applicable law, whichever is later, this bond shall ipso facto terminate and the Surety shall be relieved from any liability for any subsequent acts or omissions of the Principal. Principal shall save and keep harmless the Obligee from all losses or damage which it may sustain or for which it may become liable on account of the issuance of said license and permit. The maximum liability shall not exceed the bond penalty. Signed with our hands and sealed with our seals this, the 4th day of June 20 19 Niezgodski Plumbing, Inc, YR '� adl'.iL� Nww�I' WEST BEN UTUAL I U NCE COMPANY r evn A. Steiner, Chief Executive Officer MICHIGAN ONLY: This policy is exempt from the filing requirements of Section 2236 of the Insurance Code of 1956, 1956 PA 218 and MCL 500.2236. NB 005411 17 Page 1 of 1 PO Box 620976 1 Middleton, WI 53562 1 Phone: (608) 410-3410 1 Fax: (877) 674-2663 1 www.thesilverlining.com WEST BEND A MUTUAL INSURANCE COMPANY4 POWER OF ATTORNEY THE SILVER LININGO Bond No. 2413278 ... Know all men by these Presents, That West Bend Mutual Insurance Company, a corporation having its principal office in the City of West Bend, Wisconsin does make, constitute and appoint: Kevin A. Steiner lawful Attomey(s)-in-fact, to make, execute, seal and deliver for and on its behalf as surety and as its act and deed any and all bonds, undertakings and contracts of suretyship, provided that no bond or undertaking or contract of suretyship executed under this authority shall exceed in amount the sum of: Twenty Five Thousand Dollars (25,000.00) This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of West Bend Mutual Insurance Company at a meeting duly called and held on the 21s' day of December, 1999. Appointment ofAttorney-In-Fact- The president or any vice president, or any other officer of West Bend Mutual Insurance Company may appoint by written certificate Attorneys -In -Fact to act on behalfof the company in the execution of and attesting of bonds and undertakings and other written obligatory instruments of like nature. The signature of any officer authorized hereby and the corporate seal may be affixed by facsimile to any such power of attorney or to any certificate relating therefore and any such power of attorney or certificate bearing such facsimile signatures orfacsimile seal shall be valid and binding upon the company, and any such powerso executed and certifted byfacsimile signatures and facsimileseal shall be valid and binding upon the company in the future with respect to any bond or undertaking or other writing obligatory in nature to which it is attached. Any such appointment may be revoked, for cause, or without cause, by any said officer at any time. In witness whereof, the West Bend Mutual Insurance Company has caused these presents to be signed by its president undersigned and its corporate seal to be hereto duly attested by its secretary this 22nd day of Se tember, 2017. Attest 5 "* Christopher C. Z Bart tom°� Kevin A. Steiner Secretary Chief Executive Officer/President State of Wisconsin ..�... County of Washington On the 22nd day of September, 2017, before me personally came Kevin A. Steiner, to me known being by duly swom, did depose and say that he resides in the County of Washington, State of Wisconsin; that he is the President of West Bend Mutual Insurance Company, the corporation described in and which executed the above instrument; that he knows the seal of the said corporation; that the seal affixed to said instrument is such corporate seal; that is was so affixed by order of the board of directors of said corporation and that he signed his name thereto by like order., aaTnr f uli Atotporate edurn PUSL. c ."° Senior Attorney "ruks` `V Notary Public, Washington Co., WI ,d, � °'` My Commission is Permanent The undersigned, duly elected to the office stated below, now the incumbent in West Bend Mutual Insurance Company, a Wisconsin corporation authorized to make this certificate, Co Hereby Certify that the foregoing attached Power of Attorney remains in full force effect and has not been revoked and that the Resolution of the Board of Directors, set forth in the Power of Attorney is now in force. Signed and sealed at West Bend, Wisconsin this 4th day of June 2019 RP r` "- SEAI'�� Heather Dunn Vice President — Chief Financial Officer Ngkei Any questions concerning this Power of Attorney may Mutual Insurance Company. directed to the Bond Manager at NSI, a division of West Bend 1900 & 181h Ave. West Bend, W1 53095 1 ph (262) 334-6430 1 1-800-236-5004 1 fax (262) 338-5058 1 www.thesilverlining.com NIEZPLU-01 40�CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 6/412019 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: ff 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 riohts to the certificate holder in lieu of such endomement(s). PRODUCER Daft Beny Insurance Agency Inc. PRONE 64101 Ironwood Road 18& Nay Ertl: (574) 255-6222 South Bend, IN 46637 Jokss, busines cibirm INSURED Nlezgodski Plumbing, Inc. PO Box 3096 South Bend, IN 40619 F: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSU INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHEI CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS R TYPE OF INSURANCE JA , 5 . POLICY NUMBER raPi wLIaw YsvEvPrFvz 1. trinnnwr I_1 A COMMERCIAL GENERAL LIABILITY CUMMS-MADE [�] OCCUR L AOORE TE LIMIT APPL S PER: POLICY j&OT- LOC 8/21/2018 1 8/21/2019 AUTOMOBILE LIABILITY 'I X ANYAUTO 495062 8/21/2018 8/21/2019 OWNED SCHEDULED AURRTEEO��S ONLY AUTOSy A�TOS ONLY At9i0 Q A UMBRELLA LIAB AI OCCUR EXCESS LIAR CLAIMS -MADE �A4950632 8/21/2018 6/21/2019 DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE YIN C0190699-01 8121I2018 812112019 9-1il.- al�in RIM EXCLUDED? N ! A '. If vee, dfireeasvibe 1uuFnid)er 254-2630 IED NAMED ABOVE FOR THE POLICY PERIOD t DOCUMENT WITH RESPECT TO WHICH THIS ED HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS _..� CUEN 15000,000 AG� T O RENTED 9$ 300,000 MED EXP 5,000 PERSONAL 8 ADV INJ RY 1,000,000 OENERALAGGREGATE 2,000,000 PRODUCTS - COMP/OP AGG 2,000,000 COMSINED SINGLE �.WfT 1,000,000 BODILY INJURY (PE@ oeusnn) BODILY INJURY (Per accidBnt r %tOPentEft Y AI IAGE 2,000,000 EACH OCCURRENCE AGGREGATE s 2,000,000 X PER 0 E�,m,mm-EAGHAC I ENT 500,000 EL. DISEASE -EA EMPLOYEE S 600,000 500,000 OI E E -POLICY IICCY LIM DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of South Bend Board of Public Works THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ty ACCORDANCE WITH THE POLICY PROVISIONS. 227 W. Jefferson Blvd. South Bend, IN 46601 .. AUTHORIZED REPRESENTATIVE ACORD 2512016103) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 'Niez odski Plumbin , Inc. From: Kim Paradine <kim@dbimail.com> Sent: Tuesday, June 04, 2019 2:40 PM To: Niezgodski Plumbing, Inc. Subject: Bond for City of South Bend -Board of Public Works Attachments: Niezgodski City of South Bend Bond.pdf; Niezgodski City of South Bend Cert.pdf Good afternoon, Attached is the bond for the City of South Bend -Board of Public Works effective 07/16/2019. This will replace the expiring bond with your previous carrier. This was the last bond we had on the list to complete, if you need any others, please let me know. If you have any questions, please let me know. Thank youl Al r X %Aw6 Dan Berry Insurance Agency, Inc. 54101 Ironwood Rd. PO Box 6009 South Bend, IN 46660 Phone: 574-255-6222 Toll Free: 800-718-1394 Fax: 574-254-2630 *Please note that coverage cannot be bound or altered via email. Once your email is received and the requested change has been made we will send confirmation of the requested change. Email all general inquires to our business email at: business@dbimail.com 1 NIEZPLU-01 ,,, AA" DATE (MM/DD/YYYY) CEWRTIFICATE OF LIABILITY INSURANCE 8f20P2019 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. IMPORT ANT: 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 to the certificate holder in lieu of such endorsement(a . .. .... ...__ _--...... -- ..-__ PRODUCER .HCR# CT. ..... ... Dan Berry Insurance Agency Inc. PHONE FAX 54101 Ironwood Road (NC„ No! Ext) 574) 255-6222 1/uc, rva/;(574) 254-2630 'South Bend, IN 46637 .SS,.1MSS, r6s1ness6dbfsll c ...cortll.............................. �. INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:West Bend Mutual Insurance Co 153-- . ..................... INSURED .INSURERSFirstComp Insurance Company,_ ___, ,_,._ „27626 ..., Niezgodski Plumbing, Inc. iNsuRER,c PO Box 3096 INSURER0 South Bend, IN 46619 .._,...... ...... ..._-------- .... ------ . _ __ ..-------_- INSURER E . INSURER F : COVERAGES CERTIFICATE NUMBER: REVISIONNUMBER: 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 _ ADDL SUER: POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER LIMITS A X COMMERCIAL GENERALLIABWTY-�� 1 000,000 ,EACH OCCl1RRENCE ___ $ CLAIMS -MADE X occuR A495062 8/21/2019 8/21l2020 DAMAGE Tea RIrN r10 300,000 PI �IAfl4d�[Eaisl nnEDxP (nny one,erso�? ...... 5,000 .. _ PERSONAL & ADV IN„ URY $ 1,000,000 ,. TE C LN OLGuCY1ATEjE T APPLIES PER: P $ 2 000,000 � PRODUCTS 7 COMP/OP,AGG ,$ 2 000,000 OTHER` $ A AUTOMOBILE LIABILITYOMBINI.D SINGLF umi'r 1,000,000 _(9A"o%W llt.. X ANY AUTO A495062 8/21/2019 8/21/2020 BODILXINJURY(Perperson�j $....... ... OWNED ITOS HEDULED AUTOS ONLY �p7BQD14 YINJURY (Per accident] $ ..... ...._— AUTOSONLY 'COS��%� RNt3PECTY AMAGE S -.- .,.., ,,.,..... PR PE i�nR ..... _ . ... A 1........... _._ ...._......_ ....�...WWmmWW� UMBRELLA LIAB OCCUR EAGH pCGURRENCE....___ .. 2,000 000' EXCESS IJAB CLAIMS MADE A495062 8/21/2019 8/21/2020 AGGREGATE DED RET ENTIGN $ 2,000,000 ANY PROPMETOMPAR I N RI LIABILITY Y/ N STATUTE J RH ... PER WC0190699-07 8/27I2019 8/21/2020 500,000. WORKERS�RryCOMPENSATIONAND ERJL'XECUTIVE � N / A E.L.EACH ACCIDENT,..., ..... $ ....... , ... .500,000 rci etta Lln EXCLUDED^r y E.L, pISEASE - EA EMPLOYE E..$ _ If DESCRIPOI^i OF OPERATIONS b. aw...................ww..._.,... _._................................_........_........m.,:.................................... ..E L DI6 -,_.. .-...... - --- EASE -POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached U more space is required) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of South Bend Board of Public Works THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tY ACCORDANCE WITH THE POLICY PROVISIONS. 227 W. Jefferson Blvd. South Bend, IN 46601 AUTHORIZED REPRESENTATIVE ry ' ;i,, ACORD 25 2016/03 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 0 00 00 g W Indiana Professional Licensing Agency Indiana Plumbing Commission 402 W. Washington Street, W072 Indianapolis, IN 46204 4��rta Plumbing Corporation License Number Expire Date ....................... .._..... . .......... ............................ C089200225 12/31 /2021 Eric J. Holcomb Governor State of Indiana Niezgodski Plumbing, Inc. Deborah J. Frye Executive Director Indiana Professional Licensing Agency Indiana Professional Licensing Agency 402 W. Washington Street, W072 Indianapolis, IN 46204 Plumbing Corporation License Number Expire Date C089200225 12131 /2021 Niezgodski Plumbing, Inc. err Indiana Professional Licensing Agency Indiana Plumbing Commission 402 W. Washington Street, W072 Indianapolis, IN 46204 Plumber Contractor License Number Expire Date PC88701935 12/31 /2021 Eric J. Holcomb Governor State of Indiana David L Niezgodski Deborah J. Frye Executive Director Indiana Professional Licensing Agency Indiana Professional Licensing Agency 402 W. Washington Street, W072 Indianapolis, IN 46204 Plumber Contractor License Number Expire date PC88701936 12/3' /2021 David L Niezgodski Signature 04 ,� CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS REQUEST FOR APPLICATIONS Sealed applications shall be received no later than 9:30 a.m., EST, on November 12, 2019, at the Office of the Board of Public Works, Ste. 1316, County -City Building, 227 W. Jefferson Blvd., South Bend, Indiana, 46601 for: WATER WORKS UTILITY SERVICE LINE REPAIR PROGRAM SUMMARY: The Board of Public Works of the City of South Bend ("City"), on behalf of the Water Works Utility is soliciting applications from qualified vendors to serve as preferred vendors for its Service Line Repair Program at the rates herein for one calendar year. Project description: The City is authorized by Sections 17-49 through 17-55 of the City's Municipal Code to offer this Service Line Repair Program to repair water service line leaks located between the house or building and the water main line which would otherwise be the sole responsibility of the property owner. It is the purpose of this request to establish a list of qualified vendors who will repair water service line leaks at the rates established herein. The board will open the applications at 9:30 a.m., EST. on November 12, 2019, in the Board of Public Works Meeting, Ste. 1308, County -City Building, 227 W. Jefferson Blvd., South Bend, Indiana, 46601. Representatives of the City will review applications and notify vendors if they have been accepted into the program pursuant to the terms below. Applications must meet the minimum specifications as provided herein. There is no scoring matrix as all qualified vendors whose applications meet the minimum specifications and who meet and accept the following required conditions will be accepted into the program: • Plumber Contractor License in Indiana; and • Worker's Compensation Insurance; and • Performance bond in the amount of $25,000 or cash bond in the amount of $25,000; and • Proof of Commercial General Liability Insurance per Person in the amount of $50,000; and • Proof of Commercial General Liability Insurance per Occurrence in the amount of $1,000,000 • Three (3) year warranty on all work performed through this program. • Must follow City of South Bend Department of Public Works Design & Construction Standards. • Availability for on -call emergency response scheduled on a weekly rotation which includes before/after normal business hours, weekends and holidays. Emergency repairs require completion within 24 hours. Regular repairs require completion within five working days. • Ability to work in year-round adverse weather conditions. • Must follow IUPPS 811 compliance prior to and throughout all excavation work performed. • Customer contact prior to repairs with account information provided by the Water Works Utility. • Responsible for the planning, set-up and removal or subcontracting of all necessary traffic control according to INDOT requirements found in the Indiana Manual on Uniform Traffic Control Devices and the ability to work safely on heavily trafficked streets. • Ability to pinpoint water leaks and trace water service lines. • Must be fully equipped to work safely in underground excavations five feet deep or greater in compliance with OSHA trenching and excavation safety requirements. Company safety manual must be followed and a minimum requirement of two qualified persons for all excavations. • Ability to temporarily freeze water service lines to replace inoperable and/or leaking curb valves. • Must have experience working on water lines in the City of South Bend including new service line installation using open trench excavation and trenchless ground piercing methods. New service line installation will be paid per foot for one -inch service line and only Type K copper tubing pipe is allowed. The water line shall have a minimum earth cover of five feet and a maximum of six feet. • Responsible for the preparing and pouring or subcontracting of all sidewalk, driveway and street cuts, according to City specifications. Four inches of depth for sidewalks, six inches of depth for driveway and driveway approaches. Street cuts must match existing depth, but not be less than eight inches minimum. • Responsible for repairing all grass/sod property damage caused by excavation work by spreading topsoil and grass seed within two calendar weeks of leak repair. A list of all repairs completed in grass during the winter season must be kept for returning to complete the topsoil and grass seed work at the start of the spring season. • A Plumber Inventory Tracking Form must be e-mailed to Water Works Utility management staff with details for each leak repair performed within one calendar week of repair date. • Invoices (two copies required) for work performed must be delivered to 915 S. Olive St. by the fifth day of the following month. All material provided by the Water Works Utility must be indicated on the invoices. City inspection and approval prior to payment being remitted within 45 days of receipt. • A Plumber Material Request Sheet must be e-mailed to Water Works Utility management staff when requesting provided parts. All material requests must be picked up at 915 S. Olive St. the following business day between the hours of 7:30am and 3:OOpm unless otherwise specified by Water Works Utility management staff. Flat Rate for Stop Rox Repairs Applicants will unearth a single excavation up to five cubic feet in grass for a flat rate of $425. For stop box repairs that require the removal of a hard surface, such as asphalt or concrete, the flat rate is increased to $525. This flat rate will include all equipment, material and labor necessary to replace the stop box and rod. This flat rate will be used for all emergency repairs made during normal business hours. A curb valve found to be inoperable and/or leaking must be replaced, and the repair is billed as a basic service leak at the rates described herein. Flat Rate for basic Service Leak Repairs: Applicants will unearth a single excavation up to five cubic feet in grass for a flat rate of $1,450. For basic leak repairs that require the removal of a hard surface, such as asphalt or concrete, the flat rate is increased to $1,550. This flat rate will include all equipment, material and labor necessary to replace the curb valve, stop box and rod or repair a single leak on a three -feet or less section of the service line. This flat rate will be used for all emergency repairs made during normal business hours. Repairs that require exceeding these specifications to complete must be reported to Water Works Utility management staff to determine if a leak repair is not considered basic repair due to special circumstances. Any special circumstance requires City approval and the repair is billed for equipment, material and labor at the rates described herein. Special Circumstance Plumber bates for Eui ineptMaterial and Gabor: Equipment Rate ,pea Job.:, Pneumatic Ground Piercing Mole $150 Trench Shoring/Shield Box $130 Arrow Board $125 Air Compressor $110 Hammer/Rotary Drill $95 Partner Saw $90 Barricades $85 Freeze Kit $80 Plate Compactor $75 Trash Water Pump $50 Work Truck $40 Liqui ment Rates per Hour: Vactor $300 Backhoe $120 Dump Truck/Trailer $70 ttcrr..�l,_ at..5- r..�k #53 Recycled Concrete Backfill $90 Black Dirt & Seed $90 Labor Rates per Hour: Plumber $80 Laborer $60 Special Circumstances include, but are not limited to: • Any leak repair that requires subcontracting for heavy traffic control. • Any leak repair that requires more than a single excavation. • Any leak repair that requires excavating greater than a five feet square area. • Any leak repair that requires excavating greater than five feet of depth and must have trench shoring or a shield box installed for OSHA compliance. • Any leak repair that requires a portion of the street to be removed. • Any leak repair that requires extensive landscape removal. • Any leak repair involving the foundation of the structure. • Any service line repair that requires more than a single leak to be repaired. • Any leak repair that requires replacing any length of the service line greater than three -feet. • Emergency leak repair designated by the Water Works Utility to be completed before/after normal business hours, weekends and holidays. The successful applicants shall comply with the City's ordinance and all other federal, state and local laws and regulations governing nondiscrimination in employment. The City reserves the right to accept, negotiate scope, or reject any or all applications. Complete application instructions are available for download by visiting the City of South Bend's web page at ww _ww+ sout1ibczpdhi:.W1y: X Click on "I'm Looking For" X Click on "Doing Business in South Bend" X Click on "City Contracts — Invitations to Bid" X Click on "REQUIRED: Registration Form" to register your company. X Select and Print or Download the specifications You must register to receive addenda and updates to the specific bid/proposal you are interested in. Failure to do so could render your bid non -responsive to the specifications. There is no charge for the specifications. The specifications are also available for review only during regular working hours in the Department of Public Works, Ste. 1316, County -City Building, 227 W. Jefferson Blvd., South Bend, Indiana, 46601. Questions should be directed by email to Darric Cole, at The City reserves the right to review and audit all documents related to this application and to request additional information as determined necessary. Failure to comply with the City's request may be deemed grounds for dismissing the application. Applications must include the Non -Collusion Affidavit, Non -Debarment Affidavit, Employment Eligibility Verification, and Non -Discrimination Commitment Form. BOARD OF PUBLIC WORKS Linda M. Martin, Clerk Publish two (2) times: October 25, 2019 November 1, 2019