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Opening of Bids - Gemini at Colfax Exterior Renovations – Proj No. 119-103 - Bokon Masonry Inc.
CITY OF SOUTH BEND, INDIANA"k, b� � t CONTRACTOR'S BID FOR PUBLIC WORK CHECKLIST FOR BIDDERS Project Name Gemini at Colfax Apts. — EXTERIOR RENOVATIONS Project No. 119-103 For Bids Due February 2020 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 X or Bid Bond. Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely X_ executed. Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and X 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 met, also provide Evidence of Good Faith Efforts Form [MWBE-2.0] and MBE/WBE Contacted X Form [MWBE-2.1]. X Acknowledge Receipt of 3 Addendum(s) included with the bid. X All required additional information is included with the bid. Proposal statements and other affidavits all signed by the proper party with name either X printed or typed underneath signature. X This checklist submitted with the Bid. This checklist is provided for bidder's use in assuring compliance with required documentation; however, it does not include all specifications requirements and does not relieve the bidder of the need to read and comply with the specifications. Bidder: Bokon Masonry Inc. Date: 2/21/2020 By Authorized Representat` Signature: Print Name & Title: R4.. Bokon President Version 4/2/2019 Contractor's Bid for Public Works - 1 Waste Management, and other pickup services as requested to ensure collection services are maintained. The Contractor shall be required to collect bins, place them in a common point for easy access by automated truck services, and redistribution after pickup as requested. 2. The Contractor shall be responsible for snow removal within the project limits and shall coordinate with City of South Bend Public Works. The Contractor is responsible for protecting his/her/its project site from excessive wear and tear during snow removal. XXIII. PLANS A. Prevailing Specifications: City of South Bend Design and Construction Standards B. Additions: 1. The plans consist of (6) Sheets. 2. The specifications consist of Divisions 1, 2, 4, 7, 8, 13, & 33 and are attached below. 3. The work shall conform to the plans and specifications. 4. The drawings are schematic in nature. 5. The CONTRACTOR is responsible for estimating dimensions and quantities of materials. 6. In the event that the Special Provisions and the Plans conflict, the Special Provisions shall govern. Version 8/19/2019 Special Provisions - 10 BID/PROPOSAL CITY OF SOUTH BEND Project Name: Gemini at Colfax Apts. — EXTERIOR RENOVATIONS`4 ^, Project Number: 119-103 For Bids Due: February ", 2020 Contractor Name: Bokon Masonr Inc. BASE BID —Division A Item p Quantity Unit Unit Price T.. _— cunt No. Description Total Amount 1 Division A: Roof remove and 1 LS re lacement. 2 Division A: Deck repair 100 SF BASE BID TOTAL BASE BID — Division B Item No. Description p Quantity Unit Unit Price Total Amount Division B: Masonry Parapet Rebuild _ ....... 1 section 1 (see drawing page A2.4) — rebuild parapet including finials & 1 LS $243,097.00 pedestrian protections. Division B: Masonry Wall Repair section 2 2 (see drawing page A2.4) — repair 1 LS 17 5 04 5 indicated wall areas including at two , .0 removed fire stairs. 3 Division B: replace additional 5 SF 'Chicago 1 5 SF .......... ._..... Common' wall veneer brick 1151 .00 BASE BID TOTAL $ 418 ,_142 .00 BASE BID —Division C Item Description Quantity Unit No. Unit Price Total Amount 1 Division C Base Bid: replace 2 fire stairs 1 on west side of buildin . LS BASE BID TOTAL BASE BID — Division D Item Description No. _—_ Quantity Unit Unit Price Total Amount ...�._._--- Division D Base Bid: New water service .. . _ 1 from Washington St. to south building 1 LS foundation wall. Landsca a repair. BASE BID TOTAL (cont. next page) Version 4/2/2019 Contractor's Bid for Public Works - 7 The above bid is accepted this following conditions: Contracting Authority Members: ACCEPTANCE day of 0 , subject to the PART II (For projects of $150,000 or more — IC 36-1-12-4) Governmental Unit: City of south Bend , Indiana Board of Public Works Bidder (Firm) Bokon Masonry Inc. Date (month, day, year): February 20, 2020 These statements to be submitted under oath by each bidder with and as a part of his bid. Attach additional pages for each section as needed. 2 SECTION I EXPERIENCE QUESTIONNAIRE What public works projects has your organization completed for the period of one (1) year prior to the date of the current bid? Completion Contract Amount Class of Work Date Name and Address of Owner 237,713.00 Masonry June 2, 2019 F—dn 6. 03U. .Way �8.uft B®n®, IN 4W6 What public works projects are now in process of construction by your organization? Expected Contract Amount Class of Work Completion Name and Address of Owner Date 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 TWA. .......... ....._ day of r b 20 20 o ko kx IVI A S a rim_!!`, ._._....._.. Aonfi,,a,)r/Bidder (Firm) :. Notary Public of CoMOLLY M BELLE ANTE�' ,retractor/Bidder or Its Agent ,01 AAt dVll coup of p, . end the sit of Indiana // ° ssion lVt�rnG r l Pp 1 70 9 k% 13 G /�o r" ___ _ yCOM nlssion Expires loll?/, 0 Prince Name and Title c ` kbrndr Subscribed and sworn to before me this "39 day of A:,e� _ 20_—�O M Commission Expires `" "ti �,.]'NotY P County of Residence Version 4/2/2019 Contractor's Bid for Public Works - 6 Project Name: Project Number: For Bids Due: Contractor Name: BIDIPROPOSAL CITY OF SOUTH BEND Gemini at Colfax Apts. EXTERIOR RENOVATIONS 1 19-103 February,W, 2020 Bokon Masonry Inc. BASE BID — Division A Item Description Quantity Unit Unit Price Total Amount No. _......... 1 Division A: Roof remove and 1 LS P .........._.ent. re lacem _._.. . 2 Division A: Deck repair 100 SF BASE BID TOTAL BASE BID — Division B ......... ...... _ ..�......... Item .... „� Amount . ,. No. Description Quantity Unit Unit Price Total . .........ion B: Masonry Parapet Rebuild 1 section 1 (see drawing page A2.4) — 1 LS $243,097.00 rebuild parapet including finials & pedestrian protections. Division B: Masonry Wall Repair section 2 2 (see drawing page A2.4) — repair 1 LS $175,045.0cl indicated wall areas including at two _ removed fire stairs. 3 Division B: replace additional 5 SF _.... �1 6mSFmmmITmm ��� _......e_........_...� Chicago Common' wall veneer brick 1151 .00 BASE BID TOTAL $ 418 , 142 . 00 BASE BID — Division C Item No. Description Quantity Unit Unit Price TotalAmount 1 Division C Base Bid: replace 2 fire stairs 1 LS on west side of building. BASE BID TOTAL BASE BID — Division D _. .............. Item Description Quantity Unit Unit Price Total Amount No. .. �.._....._ Division D Base Bid: New water service 1 from Washington St. to south building 1 LS foundation wall. Landscape re air. BASE BID TOTAL (cont. next page) Version 4/2/2019 Contractor's Bid for Public Works - 7 I. PRE -QUALIFIED BIDDER CHECKLIST (a) Acknowledgements: (i) X By checking this box, I hereby acknowledge that I am a pre -qualified bidder with the City of South Bend and that I have met the pre -qualification requirements within the last twelve (12) months. A copy of my Pre -Qualification verification letter is attached. (ii) X By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided by me, and may also conduct random inquiries of my current and prior customers. (b) Attachments: (i) 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) X Statement on staffing capabilities, including labor sources. This statement indicates and ensures I have sufficient employees on staff to complete the work. It outlines how I intend to meet the staffing needs of the work. (iii) X List of projects of similar size and scope of work performed in all areas, including the State of Indiana, within the last three (3) years. (iv) X For every project, submit evidence of participation in apprenticeship and training programs, applicable to the work to be performed on the project, which are approved by and registered with the United States Department of Labor's Office of Apprenticeship, or its successor organization. Version 5/16/2019 General Conditions - 8 PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED) (a) Acknowledgements: (i) _ By checking this box, I hereby acknowledge that I am not a pre -qualified bidder with the City of South Bend. (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) _ 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) _ 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). List identifying all former business names. Any determinations by a court or governmental agency any violations of federal state, or local laws including, but not limited to, violations of contracting or antitrust laws, tax or licensing laws, environmental laws, Occupational Safety and Health Act (OSHA), or federal Davis -Bacon and related Acts, within the preceding five (5) years. (iv) 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 5/16/2019 General Conditions - 9 BID/PROPOSAL CITY OF SOUTH BEND���1 Project Name: Gemini at Colfax Apts. — EXTERIOR RENOVATIONS "AaA/< Project Number: 119 103 For Bids Due: February 11, 2020 Contractor Name: Bokonw Masonry Inc_ Bidder (Firm): Bok_o,n wwwMasonry Inc ........... .. _---- Address: 56571 Pear Rd. City/State/Zip: South Bend, __IN Telephone Number: 574 993-6771 46619 By (Signature) R ar n Bokon (Printed Name of Person Signing) Version 4/2/2019 Contractor's Bid for Public Works - 8 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY DEVELOPMENT PROGRAM FORM MWBE-1.0 MBEIWBE PARTICIPATION This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MBE/MBE participation. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business. Project Number: 119-103 Project Name: Gemini at CoIf9jA ;�qrnp!21!� — EXTERIOR RENOVATIONS Bidder: Bokon Masonry Inc. ................. . ... Total Bid Amount: ...$4-18-,142.00 MBE/WBE Goal: -7-.-87% Page 1 of Name & Address a MIEM11 Primary Contact Person I Scope of Work to be Performed Dollar Amount of Percentage of Total (Narnerrelaph-- one) (Attach scope/schedule if you need additionalMBENVBE Component Scaffold Expres I Rick 2423 Huffmeiste Perlini ypress,Texas i Submitted by: „wwBokon Print Name Scaffolding for Canopy $3952.60 Sidewalk protection Version 4/2/2019 Contractor's Bid for Public Works - 9 2/21/20 (ix) Written statement of any federal, state or local tax liens or tax delinquencies owed to any federal, state or local taxing body in the preceding three years. (i) List of projects of similar size and scope of work performed in all areas, including the State of Indiana, within three (3) years prior to the date on which the bid is due. Date: 2/21/2020 _J : (Sign re) Ryan Bokon (Print Name Here) Bokon Masonry Inc. (Name of Company) 56571 Pear Rd. (Address of Company) South Bend (City) Indiana 46619 (State) 574-993-6771 (Telephone Number) Version 5/16/2019 General Conditions -10 CITY OF SOUTH BENDp� MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY w DEVELOPMENT PROGRAM r ,„ FORM MWBE-2.0 EVIDENCE OF GOOD FAITH EFFORTS This completed form should be included as part of the Bids documents related to City of South Bend Public Works Projects requiring Good Faith Efforts to obtain MBE/WBE participation. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business as defined by the Indiana Department of Administration ("IDOA"). Project Number: 119-103 Date: 2 /21 / 2 0 2 0 Project Name: Gemini at Colfax Apts — EXTERIOR RENOVATIONS Bidder: Bokon Masonry Inc. �kon Contact Person: Ryan Bo Telephone: 574-993-6771 ..„wwwwwwww a� -- Address: 56571 Pear Rd. City: South Bend State: IN zip: 46619 Email: ryan.bokonmasonrvinc@ahoo,gjm__ .. 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 ......... MBEIWBE 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 MBE/WBEs 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 MBE/WBEs, including providing such MBE/WBE's with adequate information about the plans, specifications and other 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) ..................................... .....W CONTRACT RECORDS: The bidder has maintained the following records for each MBENVBE that has bid on the subcontracting opportunity: 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. ......._..W _.... *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 4/2/2019 Contractor's Bid for Public Works - 10 This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring contacted MBE/WBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business. PAGE 1 OF 1 Project Number: 119-103 MBE/WBE Participation Goal Project Name: Gemini at Colfax ApartmeITm EXTERIOR RENOVATIONS nts — . Bidder: Bokon Masonry Inc. By ....:ram. ] /0 dAiCgjt!_rre_)�_ (Title) (Date) MBE/WBE Firm .......... c-'ff 1ding EXpress Owner or Contact atMBE/WBEFirm Contact/ Rick Perlini Telephone: Fax281-890-6150 Email: ordersCscaffoldex ress.com $_Q—592-171� ...__ TYPE OF WORK SOLICITED FOR THIS PROJECT: Scaffolding for Sidewalk Canopy RESULTS OF CONTACT WITH THE MBE/WBE FIRM: Recieved Estimate MBE/WBE Firm Owner or Contact at MBE/WBE Firm Telephone: Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBE/WBE FIRM: Version 4/2/2019 Contractor's Bid for Public Works - 11 3. Have you ever failed to complete any work awarded to you? No If so, where and why? List references from private firms for which you have performed work. Hollady Construction Group 3454 Douglas Road, Suite 250 South Bend, IN 46635 South Bend Heritage Foundation, Inc 803 Lincoln Way West south Bend, IN 46616 SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE Explain 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 governmental unit to consider your bid.) Bokon Masonry Could start the project as soon as March 16, 2020. we currently have 8 employees and are a Union Masonry subcontractor who can pull from the Local Union of Bricklayers if more is needed. We own the equipment needed to complete the project as we have completed the Masonry on the Gemini project that is on Washington St. Please list 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. None 3. If you intend to sublet any portion of the work, state 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 governmental unit in the event that you subsequently determine that you will use a subcontractor on the proposed project. No subcontractors intended 4. What equipment do you have available to use for the proposed project? Any equipment to be used by subcontractors may also be required to be listed by the governmental unit. Scaffolding Tube and Towered, Mortar mixers, Trucks, Dump truck, Trailers, Saws, Grinders, Forklifts/Lulls/Telehandlers. Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing your proposal? If not, please explain the rationale used which would corroborate the prices listed. I have priced the brick materials from Rose brick and they stand behind there prices for the materials. 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 governing body awarding the contract must be specific enough in detail so that said governing body can make a proper determination of the bidder's capability for completing the project if awarded. e,4uto-Owners INSURANCE BOND NUMBER: BD1 72- w_ww LIFE • HOME • CAR • BUSINESS BID BOND KNOW ALL MEN BY THESE PRESENTS: That we, BOKON MASONRY INC 56571 PEAR RD .SOUTH BEND IN 46619-0801 as Principal, hereinafter called the Principal, and Auto -Owners Insurance Company as Surety, hereinafter called the Surety, are held and firmly bound unto CITY OF SOUTH BEND BOARD OF PUBLIC WORKS 227 W JEFFERSON BLVD STE 130 SOUTH BEND IN 46601-1830 as Obligee, hereinafter called the Obligee, in the penal sum of Five percent of bid dollars (5% of attached bid) for the payment of which the Principal and the Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, that WHEREAS, the Principal has submitted or is about to submit a proposal to the Obligee on a contract for MASONRY AND STAIR REPAIR NOW, THEREFORE, if the said contract be timely awarded to the Principal and the Principal shall, within such time as may be specified, enter into the contract in writing, and give bond, if bond is required, with surety acceptable to the Obligee for the faithful performance of the said contract, then this obligation shall be void; otherwise to remain in full force and effect. SIGNED AND SEALED this 24TH day of FEBRUARY, 2020.. r.Aalz Wa �W' +t , 0txs r CORPORATE . SEAL .. 14 ........ Susan -. Theisen witness OKON MASONRY INC Pri�lcitaan By - Z'�;/Z_' Auto -Owners Insurance Com any Surety Tad 0 ... By........__ Paul D. Oppenlander Attorney -in -Fact 29392 (01-18) 29 Of HWW Car ®,YBond Number Q1 27 gu'atl�Ym.. ACKNOWLEDGEMENT BY SURETY STATE OF MICHIGAN County of Eaton On this 24TH day of FEBRUARY, 2020, before me personally appeared Paul D. Oppenlander, known to me to be the Attorney -in -Fact of Auto -Owners Insurance Company, the corporation that executed the within instrument, and acknowledged to me that such corporation executed the same. IN WITNESS WHEREOF, I have hereunto set my hand and affixed my official seal, at my office in the aforesaid County, the day and year in this certificate first above written. cra UNW (W Ku�au AAWCMHarn im'IMm i1�NYdngp M.BirY�y Wp Uhxa 1� ........ — _jtt'o 44.� ...� .ate....... mm, Susan E. Theisen Notary Public in the State of Michigan County of Kent SUSAN E. THEISEN NOTARY PUBLIC -STATE OF MICHIGAN COUNTY OF KENT My Commission ExpirestetY 10, 2022 Acting In Die County o4 __tpn Print Date: 02/24/2020 Print Time: 11:09:37 AM DATE AND ATTACH TO ORIGINAL BOND AUTO -OWNERS INSURANCE COMPANY LANSING, MICHIGAN POWER OF ATTORNEY NO. BD152729 KNOW ALL MEN BY THESE PRESENTS: That the AUTO -OWNERS INSURANCE COMPANY AT LANSING, MICHIGAN, a Michigan Corporation, having its principal office at Lansing, County of Eaton, State of Michigan, adopted the following Resolution by the directors of the Company on January 27, 1971, to wit: "RESOLVED, That the President or any Vice President or Secretary or Assistant Secretary of the Company shall have the power and authority to appoint Attorneys -in -fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity, and other writings obligatory in the nature thereof. Signatures of officers and seal of Company imprinted on such powers of attorney by facsimile shall have same force and effect as if manually affixed. Said officers may at any time remove and revoke the authority of any such appointee." Does hereby constitute and appoint Paul D. Oppenlander its true and lawful attorney(s)-in-fact, to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof, and the execution of such instrument(s) shall be as binding upon the AUTO -OWNERS INSURANCE COMPANY AT LANSING, MICHIGAN as fully and amply, to all intents and purposes, as if the same had been duly executed and acknowledged by its regularly elected officers at its principal office. IN WITNESS WHEREOF, the AUTO -OWNERS INSURANCE COMPANY AT LANSING, MICHIGAN, has caused this to be signed by its authorized officer this 1 st day of August, 2016. Denise Williams STATE OF MICHIGANlss. COUNTY OF EATON ff Senior Vice President On this 1 st day of August, 2016, before me personally came Denise Williams, to me known, who being duly sworn, did depose and say that they are Denise Williams, Senior Vice President of AUTO -OWNERS INSURANCE COMPANY, the corporation described in and which executed the above instrument, that they know the seal of said corporation, that the seal affixed to said instrument is such Corporate Seal, and that they received said instrument on behalf of the corporation by authority of their office pursuant to a Resolution of the Board of Directors of said corporation. A My commission expires March 10, 2022 Susan E. Theisen Cr Sys. .MYN1'w,,kWM�X m:w��r�+raw«'pax �� c,Mwwnrw+asa ;`� 4Y,4M 0 Notary Public STATE OF MICHIGAN lss. COUNTY OF EATON f I, the undersigned First Vice President, Secretary and General Counsel of AUTO -OWNERS INSURANCE COMPANY, do hereby certify that the authority to issue a power of attorney as outlined in the above board of directors resolution remains in full force and effect as written and has not been revoked and the resolution as set forth is now in force. Signed and sealed at Lansing, Michigan. Dated this 24th Februa 2020 trtts/ �.....-...,,,,,„ day Of ry � _,Otte `CORPORATE � Y �. SEAL .r --- .............. ............ � William F. Woodbury, First Vice Preetdent, Secretary and General Counsel 2940 (10-17) Print Date: 02124/2020 Print Time: 11:09:37 AM BOKOMAS-01 FDATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE o2o .......�... ....� ........ ........ . ......... 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 CONTACT The Healy Group, Inc. PHONE NAME: Bendr, IN466D5D" Afss Drive xt). (574) 271-6000 _._. ITmmm _........ el TO'� 74 243-3214 South m` INSURED Bokon Masonry Inc. 56571 Pear Rd South Bend, IN 46619-9801 14176 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. TYPE OF INSURANCE ADO L SUOR w POLICY NUMBER mmmPOLICYFF E JMMI POLICY EXP dM117%DD/YYXYI _ LIMITS �.. ..._ . � A X COMMERCIAL GENERAL LIABILITY EACH OCCU 1,Q0o,o0Q CLAIMS -MADE CD OCCUR X CPP9874827 8/17/2019 8/17/2020 A-6E WEEff .. RLND $ 100 000 PN MEDwEXP (Any one erson $ 5,000 ,........ PERSONAL B ADV INJLIRY $._ 1,000,000 GLN AIE APPLIESPER: GENERAL AGREGATE $ 2,000,000 POLICYDt Pj CT LOC PRODUCTSGCOMP/OP mmmm WWW ^2,000,000 AGG $ A OTHER AUTOMOBILE LIABILITY --- OMUINFI} SINGLE LIMIT �Fa_ �I,4s:�I . $ 500,000 X ANY AUTO ACV9874840 8/17/2019 8/17/2020 BODILY INJURY-(Per,perSgPJ. $ OWNED SCHEDULED r AUTOS ONLY AUTOS RY (Pgrc deal),, $ UOA(LY(N,IIJ,,,,m, Ep C�Dy ���� AUTOS ONLY AUO,Y mmw„ Peic rAhGeLGL __WWW_W w $ A X UMBRELLA LIAB X OCCUR ........ EACH OCCURRENCE $ 1,000,000 LIAB CLAIMS -MADE ULC9874849 8/17/2019 8/17/2020 _ AGGREGATE _m mITmm mmm 1,000,000 _.m.. .... ........ ]:EXCESS DED RETENTION $ $ ... w A WORKERS COMPENSATION PER OTH _X AND EMPLOYERS' LIABILITY YIN ANY PR PRIETORIPARTNERIEXECUTIVE OR/PARLUDED� N/A WC 9874841 8/17/2019 8/17/2020 EACHmA C $ 500,000 FkCE Bfal M W arida oryi n NH) _ _ 500,000 EL DISEASECIDENT - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E L. DISEASE POLICY L` mm ........_ __._ LIMIT $ 500 000 DESCRIPTION OF OPERATIONS. / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) City of South Bend Is Ilsted as Additional Insured. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of South Bend THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 125 South Lafayette Blvd, Suite 100 South Bend, IN 46601 AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1316 COUNTY -CITY BuiLDING PHONE 574/235-9251 227 W. JEFFERSON Bouj,EVARD '77TZli FAX 574/ 235-9171 SOUTH BEND, INDIANA 46601-1830 K' ACK TDD 574/ 235-5567 186 CITY OF SOUTH BEND .TAMES MUELLER, MAYOR Date: To: From Subject VITOUTFITIM February 13, 2020 All Planholders Linda M. Martin, Clerk, Board of Public Works Addendum Number: 2 Project Name: Gemini at Colfax Exterior Renovations Project No.: 119-103 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: 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 bid package upon submittal. MUST also be included with your THIS ADDENDUM MAY AFFECT YOUR BID. Notes: Revised bit] documents are attactied herein. "I'liese two PDF files replace the: origitW Plans and Specifications. Changes to doctinients have been, Iiighlighted to note differences from the original. The attached documents are hereby added to the Specifications and Contract Documents and become a part of herein. 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INI ANA46601-1830 x 1865, CITY OF SOUTH BEND PETE i, "' WORKSBOARD OF PUBLIC October 17, 2018 Mr. Ryan Bokon Bokon Masonry, Inc. 56571 Pear PA.- - South Bend, IN 46619 RE: Pre -Qualification Verification Dear Mr. Bokon: P1IImF574/ 235-9251 FAx 574/235-9171 This letter serves as verification of Pre -Qualification status of your company for bidding with the City of South Bend. This Pre -Qualification status is effective for twelve (12) months from the date of this letter. Thereafter you are required to re -submit a complete application for continuation of pre -qualification status prior to December 31 for the upcoming calendar year. A copy of this Verification Letter intist be included with every bid exceeding $150,000 submitted to the City of South Bend Board of Public Works, along with your Pre -Qualified Bidder Checklist and attachments. If you have any further questions regarding this matter, please call this office at (574) 235-9251. Sincerely, Linda M. Martin, Clerk GARY A. GILOT DAVID P. RELos t,(ZA11I:'W"'!-I A. ii%MARAIINK JAG' -'s A. MI )ELUilk T1II"III.SE J, DORAU Comparable Projects Completed in Past 3 Years Promenade at Founders Square, GC — Hollady Corporation Portage, IN. Gemini at Washington Street, GC- South Bend Heritage Foundation, South Bend, IN. , 40L"' Ryan Bokon Bokon Masonry Inc. Statement On Staffing Capabilities Bokon Mclsonry Inc. is a member of the International Union Of Bricklayers and Union Of Bricklayers Local 18 Indiana. Local Business Agent — Kevin McClanahan 574-320-6376. 441- 1�54, Ryan Bokon Bokon Masonry Inc. VENDOR MAINTENANCE FORM Print Form Requesting Department:Engineering Contact:Kyle Silveus Phone:574-235-9083 Remit To Address - (Send payments to this address) Supplier Name: Bokon Masonry Inc. Address 1: 56571 Pear Rd. Address 2: City, State, ZIP: South Bend, IN 46619 Contact: Ryan Bokon Indicate below if P.O. Address is different. Address/P.O. Box: N/A Date:2018-10-16 Action: (: Add C Inactivate E-mail: ryan.bokonmasonryinc@yahoo.com Phone: 574-993-6771 FAX: 574-404-6105 Tax ID# / SS#: 46-0639161 W-9 Form is required and must be attached City, State, ZIP: N/A Vendor Qualifications: Type of Items Supplied: Masonry Construction and Repairs and Restoration # of years in business: 7 # of employees: 8 Sales - $'s Annual: $800,000.00 DUNNS #: Major customers: South Bend Heritage Foundation Is the business certified as a Disadvantaged Business enterprise? ('Yes (*-No Type: (' WBE ( MBE Other: If MBE, please indicate ethnic origin: Name & address of agency that provided your MBE or WBE certification: Date Certified. Date Certification Expires: Note: Vendor record must be created prior to a commitment for supplies or services. Commen Purchasing Approval: Instructions: 1. Complete Form 2. Print to PDF CREATOR (which will create a file) 3. Attach the file to an E-MAIL addressed to: GKING@SOUTHBENDIN.GOV Rev.082412a FormWW9 Request for Taxpayer Give Form to the (Rev. November 201-1) Identification Number and Certification requester. Do not Department of the Treasury send to the IRS. Internal Revenue Service ► Go to wwwJrs.gov1FormW9 for instructions and the latest information. 1 Nairn (its shown on your income tax return). Name is required on this Ilne; do riot leave this tone blank.. Bokon Masonry Inc. 2 Business narneldisregarded entity name, if different from above ai w m a C O ai c ao `o c c CL .v CL d r 0) a) 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to following seven boxes. certain entities, not individuals; see instructions on page 3): ElIndividual/sole proprietor or ElC Corporation ❑✓ S Corporation ElPartnership ❑ TrusVestate single -member LLC Exempt payee code (if any) ❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ► Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check Exemption from FATCA reporting LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is code (if any) another LLC that is not disregarded from the owner for U.S, federal tax purposes. Otherwise, a single -member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner. (._.i Other (see instructions) ► 5 Address (number, street, and apt. or suite 56571 Pear Rd. i City, state, and ZIP code South Bend, IN 46619 account number(i) here ler Identification Number i applies to accounts maintained outside the U.S.) Requester's name and address (optional) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter. Social security number or Identification number DO���®�ivoo Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, ,yob( are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later. Sign Signature of Here U.S. person Do - General Instru+tiins Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov1F6rmW9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099-INT (interest earned or paid) Date ► • Form 1099-DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231X Form W-9 (Rev. 11-2017) 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 4 page document consisting of the following records filed in this office: Certification Date: February 19, 2020 Business Name: BOKON MASONRY INC. Business ID: 2012072500011 Transaction Date Filed Articles of Incorporation 07/24/2012 Business Entity Report 07/31/2018 Total No. of pages U7a No. of 2 11 In Witness Whereof, I have caused to be affixed my signature and the seal of the State of Indiana, at the City of Indianapolis, February 19, 2020 CONNIE LAWSON SECRETARY OF STATE 2012072500011 / 12541356 All certificates should be validated here: https://bsd.sos.in.gov/ValidateCertificate Expires on March 20, 2020. Page 1 Of 5 CertificatelD:12541356 APPROVED AND FILED CONNIE LAWSON INDIANA SECRETARY OF STATE 07/31/2018 11:42 PM BUSINESS ID 2012072500011 BUSINESS TYPE Domestic For -Profit Corporation BUSINESS NAME BOKON MASONRY INC. ENTITY CREATION DATE 07/24/2012 JURISDICTION OF FORMATION Indiana PRINCIPAL OFFICE ADDRESS 56571 Pear Rd., South Bend, IN, 46619, USA YEARS 1 EFFECTIVE DATE EFFECTIVE TIME 2018/2019 07/31/2018 11:42 PM CIS"1 R1 II 9E,11C �kli III)R 4S REGISTERED AGENT TYPE Individual NAME RYAN BOKON ADDRESS 56571 PEAR ROAD, SOUTH BEND, IN, 46619, USA SERVICE OF PROCESS EMAIL ryan.bokonmasonryinc@yahoo.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. RI CiP t TITLE President NAME ADDRESS Ryan Bokon 56571 Pear Road, South Bend, IN, 46619, USA Page 4 Of 5 CertificateID: 12541356 - PAAP 1 of 7 u APPROVED AND FILED CONNIE LAWSON INDIANA SECRETARY OF STATE . 07/31/2018 1.1 42 PM ���, __ . _ �......� ..__�_.. ��...._....�..� 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 July 31, 2018. SIGNATURE Ryan C Bokon TITLE President Business ID : 2012072500011 Filing No.: 7977144 Page 5 Of 5 CertificateID:12541356 _Par-1of7_ RECEIVED 07/24/2012 03:59 PM APPROVED AND FILED CONNIE LAWSON INDIANA SECRETARY OF STATE 7/24/2012 3:57 PM ARTICLES OF INCORPORATION Formed pursuant to the provisions of the Indiana Business Corporation Law. ARTICLE I - NAME AND PRINCIPAL OFFICE BOKON MASONRY INC. 56571 PEAR ROAD, SOUTH BEND, IN 46619 ARTICLE II - REGISTERED OFFICE AND AGENT RYAN BOKON 56571 PEAR ROAD, SOUTH BEND, IN 46619 ARTICLE III — INCORPORATORS RYAN BOKON 56571 PEAR ROAD, SOUTH BEND, IN 46619 Signature: RYAN BOKON ARTICLE IV — GENERAL INFORMATION Number of Shares: 10,000 Effective Date: 7/24/2012 Page 1 of 1 Control Number 2012072600011 / DCN 2012072522228 Transaction Id TR12072400254 State of Indiana Office of the Secretary of State CERTIFICATE OF INCORPORATION of BOKON MASONRY INC. I, Connie Lawson, Secretary of State of Indiana, hereby certify that Articles of Incorporation of the above For -Profit Domestic Corporation has been presented to me at my office, accompanied by the fees prescribed by law and that the documentation presented conforms to law as prescribed by the provisions of the Indiana Business Corporation Law. NOW, THEREFORE, with this document I certify that said transaction will become effective Tuesday, July 24, 2012. �-- � . {'! `�" In Witness Whereof, I have caused to be affixed my signature and the seal of the State of Indiana, at the City of Indianapolis, July 25, 2012 =ortZ4 k= CONNIE LAWSON, SECRETARY OF STATE 2012072500011 / 2012072500011 B16 Coupq'u,Y-Cila,y BMILIANG 227 W', JIFF11H RiON ROULEVAJU) SOU I'll I BEND, IINDIIANA 4660M830 Nioi�i; 574/235-9251 FAX 574/ 235-9171 FDD 574/ 235 -5567 41 Crry oi,, Sourii BIND JAMES MIJIFILLER, MAYOR BOARD OF PUB1,1C WORKS Date: February 20, 2020 To: All Planholders ................................. From Linda M. Martin, Clerk, Board of Public Works Subj ect Addendum Number: 3 Project Name: Gemini at Colfax — Exterior Renovations Project No.: 119-103 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: 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 ��UST also be included with your bid package upon submittal. THIS ADDENDUM MAY AFFECT YOUR BID. Notes: Please see attached mes. The attached documents are hereby added to the Specifications and Contract Documents and become a part of herein. Company: Bokon Masonry Inc. Authorized Signature: Date: 2/20/2020 1316 COUN'ry-Crry BUILDING 1 f p Tvfth PHONE 574/ 235-9251 kg 227 W. IEFFERSCiN I3c�uLEvAKra " FAX 574/ 235-9171 SOUTH FIEND, INDIANA 46601-1830 � "" �� � � ,, TDD 574/ 235-5567 86. CITY OF SOUTH BEND JAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS Date: February 5, 2020 To: All Planholders From Linda M. Martin, Clerk, Board of Public Works Subject Addendum Number: 1 Project Name: Gemini at Colfax Exterior Renovations Project No.: 119-103 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: This addendum is being forwarded to you for the above referenced project. Please sign below and acknowledge receipt of this Addendum by faxing this sheet to the Board of Public Works at (574) 235-9171 within 48 hours of receipt. A copy MUST also be included with your bid package upon submittal. THIS ADDENDUM MAY AFFECT YOUR BID. Notes: The bid opening is being postponed from February 1 lth, 2020, until February 25th, 2020. Revised bid documents will be supplied the week of February I Oth. Enclosed is a revised Notice to Bidders. The attached documents are hereby added to the Specifications and Contract Documents and become a part of herein. Company: ^ - Authorized Si Date: 2/5/2020 SECTION IV CONTRACTOR'S NON — COLLUSION AFFIDAVIT The undersigned bidder or agent, being duly sworn on oath, says that he 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 include 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. He 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. SECTION V OATH AND AFFIRMATION I HEREBY AFFIRM UNDER THE PENALTIES FOR PERJURY THAT THE FACTS AND INFORMATION CONTAINED IN THE FOREGOING BID FOR PUBLIC WORKS ARE TRUE AND CORRECT. Dated at this 1{k day of ,Ce rK A6 Bokon Masonry Inc. °J P�,� HOLLY M. BELLEGANTE, I Notary Public 0 SEAL Wrhn and for the county of LaPode and the state of Indiana - Commission Number NP0716379 My Commission Expires 10/17/2026 STATE OF ) ss COUNTY OF W^ ) (Name (Title of Person Signing) ACKNOWLEDGEMENT Before me, a Notary Public, personally appeared the above -named % and swore that the statements contained in the foregoing document are true and correct. Subscribed and sworn to before me this day of ) Qil- 4=Ao-ov'�1 ��o - rn.11D Notary Pubfic My Commission Expires: % County of Residence: -J Q� O v y y � N C v O �- (n > I— c U � W O O X L - w a, U) W 4 o m c 0) � O LL Y O O E a o Z U Y coLO m 7 U) J O Q 0 Z a N LL Q CONTRACTOR'S BID FOR PUBLIC WORK - FORM 96 State Form 52414 (R2 / 2-13) / Form 96 (Revised 2013) Prescribed by State Board of Accounts PART (To be completed for all bids. Please type or print) Date (month, day, year). 2/20/2020 1. Governmental Unit (Owner): City of south Bend, Indiana Board of Public Works 2. County St. Joseph 3. Bidder (Firm):_ Bokon Masonry Inc. Address: 56571 Pear Rd. City/State/ZlPcode: south Bend, IN. 46619 4. Telephone Number: 574-993-6771 5. Agent of Bidder (if applicable): Ryan Bokon Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the public works project of Gemini At Colfax Exterior Renovations (Governmental Unit) in accordance with plans and specifications prepared by Patrick Lynch of South Bend Heritage Foundation and dated January 17, 2020 for the sum of Four hundred eighteen thousand and 1 hundred forty two dollars $ 418,142.00 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 governmental unit. If the bid is to be awarded on a unit basis, the itemization of the units shall be shown on a separate attachment. The contractor and his subcontractors, if any, shall not discriminate against or intimidate any employee, or applicant for employment, to be employed in the performance of this contract, with respect to any matter directly or indirectly related to employment because of race, religion, color, sex, national origin or ancestry. Breach of this covenant may be regarded as a material breach of the contract. CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS (If applicable) I, the undersigned bidder or agent as a contractor on a public works project, understand my statutory obligation to use steel products made in the United States (I.C. 5-16-8-2). 1 hereby certify that I and all subcontractors employed by me for this project will use U.S. steel products on this project if awarded. I understand that violations hereunder may result in forfeiture of contractual payments.