HomeMy WebLinkAboutOpening of Bids - 2020 Street & Sewer Materials Proj No. 120-005 - Ozinga Ready Mix Concrete, Inc.6-M
2020 Street and Sewer Department Materials
Project No. 120-005
March 2020
Prepared for
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Department of Public Works
lift Division of Engineering
K L 0
STir
PE11200272
STATE OF
0
& 0
V
Jacob M. Klosinski, P.E.
Registered Professional Engineer
State of Indiana No. PE11200272
FOR BIDS DUE: 9:30 a.m., April 14,2020
PRACC
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CITY ~-' SOUTH BEND, -_-
CONTRACTOR'S BID FOR PUBLIC WORK
CHECKUST FOR BIDDERS
Project Name 202OStreet and Sewer Department Materials
Project No. 120-006
ForBidsDue April 14, 2020,9:30 a.m., Local Time
From time to time the South Bend Board of Public Works finds itnecessary to reject abid because
it does not C00pk/ with statutory requirements. In preparing your bid. p|8gSe use the foU0vvDg
checklist in order to make sure that your bid is done in the proper manner.
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 EligibilityVerificetion. Non -Discrimination Commitment, and
X Certification of use of United States Steel Products or Foundry Products.
_NA Acknowledge Receipt ofAddendum(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
]K�_ printed ortyped underneath signature.
X This checklist submitted with the Bid.
This checklist is provided for bidder's use in assuring nmnn[limnue with required
documentation; however, ddoes not include all specifications requirements and does not
relieve the bidder of the need to read and comply with the specifications.
Bidder: Ozinga Ready Mix Concrete, Inc. Date:
By Authorized
Print Name @Title: Scott Underwood Sales Representative
Veraion01/28/2O20 Contractor's Bid for Public Works -1
Project Name
Project No.
For Bids Due
2¢2DStreet and Sewer Department Materials
120-005
April i4.2O2D 9:30a.m,Local Time
PART U
(Must bacompleted for all bids
Date: April 14'2O2U Bidder (Firm)
Address: 715 W. Ireland Road
Ozinga Ready Mix Concrete, Inc.
Please type orprint)
City/State/Zip: South Bend, |N4GS14 Telephone Number: (674 )291-7100
Agent ofBidder (if App|icabk): Scott Underwood
Pursuant to notices given, the undersigned offers tofurnish labor and/or material necessary to complete the
public works project of:
the City of South Bend. Indiana, in accordance with plans and specifications prepared by:
and dated April 14, 2020
for the sum of (enter the Total Bid onshown onthe Proposal)
(Enter sum of Total Base Bid plus Alternates shown on Proposal) (Numerical)
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 addenclums attached will be specifically referenced at the applicable page.
If additional units ofmaterial included inthe contract are needed, the cost ofunits must bethe same aothat
shown in the original contract if accepted by the City of South Bend. If the bid is to be awarded on a unit
basis, the itemization ofthe units shall be shown
By �X
Scott Underwood
(Printed Name of Person Signing)
ACCEPTANCE
The above bid isaccepted this
Subject tothe following conditions:
BOARD OfPUBLIC WORKS
Gary &Gikt,President
Elizabeth A. Maraclik, Member
Joseph R. Molnar, Member
Therese J.Oorau.Member
Jordan V. Gathers, Member : Linda M. Martin, Clerk
20
\ersionO1/29/202U Contractor's Bid for Public Works -2
When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit
CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION
REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON-
DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL
PRODUCTS OR FOUNDRY PRODUCTS
(Must be completed for all quotes and bids. Please type or print)
STATE OF OIC44' CN, )
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 § 5-22-1.6.5-8, as amended from time -to -time, a Contractor
is engaged in investment activities in Iran if either:
i. Contractor, its successor or its affiliate, provides goods or services of twenty
million dollars ($20,000,000) or more in value in the energy sector of Iran;
or
ii. Contractor, its successor or its affiliate, is a financial institution that extends
twenty million dollars ($20,000,000) or more in credit to another person for
forty-five (45) days or more, if that person will (i) use the credit to provides
goods and services in the energy sector in Iran; and (ii) at the time the
financial institution extends credit, is a person identified on list published by
the Indiana Department of Administration.
Version 01/29/2020 Contractor's Bid for Public Works - 4
4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any
employee or contract with a person that the Contractor subsequently learns is an unauthorized alien.
Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of Contractor's
newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3. Contractor's
documentation of enrollment and participation in the E-Verify Program is included and attached as part of
this bid/quote; and
5. Contractor shall require his/her/its subcontractors performing work under this public contract to
certify that the subcontractors do not knowingly employ or contract with an unauthorized alien, nor retain
any employee or contract with a person that the subcontractor subsequently learns is an unauthorized alien,
and that the subcontractor has enrolled in and is participating in the E-Verify Program. The Contractor agrees
to maintain this certification throughout the term of the contract with the City of South Bend, and understands
that the City may terminate the contract for default if the Contractor fails to cure a breach of this provision
no later than thirty (30) days after being notified by the City.
6. Persons, firms, 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 will consider the Contractor's good faith efforts to obtain participation by those
subcontractors 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.
Contractors seeking the award of a City contract cannot be required to award a subcontract to an MWBE;
however, they may not unlawfully discriminate against said MBE/WBE. A finding of noncompliance or a
discriminatory practice shall prohibit that Contractor 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 to which the discriminatory practice or noncompliance pertains.
7. The undersigned Contractor agrees that the following nondiscrimination commitment shall be made
a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its
agencies, boards or commissions.
Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the
performance of this contract with privileges of employment, or any matter directly or indirectly related to
employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation,
handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of
contract.
1, 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.
Version 01/29/2020 Contractor's Bid for Public Works - 5
***
Ihereby affirm under the penalties of perjurythat the facts and information contained iothe foregoing bid
for public works are true and correct.
Dated this 14Uh day of April 2020
Ozinga Ready Mix Concrete, Inc.
Signature ontractor/Bidder or Its Agent
Scott Underwood Sales Representative
Printed Name and Title
Subscribed and sworn to before me this Y of 20—Alz�
My Commission Expires
ttary P lic
County of Residence
VersionO1/28/2O2U Contractor's Bid for Public Works -6
BID NAME
FOR BIDS DUE
BID/PROPOSAL
CITY OF SOUTH BEND
2020 Street and Sewer Department Materials
April 14, 2020, 9:30 a.m., Local Time
DIVISION A - ASPHALT MATERIALS
Item
No.
Description
Quantity
Unit
Unit Price
Total
A-1
HMA Surface 11 L
15000
TON
No Bid
$ No Bid
A-2
HMA Surface 11 L MAC HD
5000
TON
$
No Bid
No Bid
A-3
HMA Surface 11 S
2000
TON
No Bid
$
No Bid
A-4
HMA Binder 8/9
1500
TON
No Bid
$ No Bid
A-5
HMA Binder 11
3000
TON
No Bid
$ No Bid
A-6
HMA Binder 11 MAC
1000
TON
$
No Bid
No Bid
A-7
HMA Base 5D
1000
TON
No Bid
$ No Bid
A-8
CMA Patch AE-300P
500
TON
$
No Bid
No Bid
A
High Performance Cold
150
EA
$ No Bid
Mix
No Bid
DIVISION A TOTAL
$ No Bid
Version 01/2912020 Contractor's Bid for Public Works - 7
BID NAME
FOR BIDS DUE
BID/PROPOSAL
CITY OF SOUTH BEND
2020 Street and Sewer Department Materials
April 14, 2020, 9:30 a.m., Local Time
DIVISION B - PCC MATERIALS
Item
No.
Description
Quantity
Unit
Unit Price
Total
B-1
Class A Concrete
2500
CY
$113.50
$ 283,750
B-2
Class A High Early
800
CY
$123.00
$ 98,400
B-3
7 Bag Mix - New City Specs
600
CY
$135.00
$ 81,000
B-4
High Early Concrete w/ Integral
350
CY
$213.00
$ 74,550
Color - Black
B-5
Flowable Fill, Removable
350
CY
$77.00
$ 26,950
B-6
Non -Chloride Accelerator added to
325
EA CY
$2.75
$ 893.75
concrete — 0.5%
B-7
Non -Chloride Accelerator added to
1000
EA CY
$5.50
$ 5,500
concrete — 1 %
B-8
Non -Chloride Accelerator added to
2100
EA CY
$11.00
$ 23,100
concrete — 2%
DIVISION B TOTAL
$ 594,143.75
Version 01/29/2020 Contractor's Bid for Public Works - 8
BID NAME
FOR BIDS DUE
BID/PROPOSAL
CITY OF SOUTH BEND
2020 Street and Sewer Department Materials
April 14, 2020, 9:30 a.m., Local Time
DIVISION C - AGGREGATE MATERIALS
Item
No.
Description
Quantity
Unit
Unit Price
Total
C-1
No. 23 Sand
5000
TON
No Bid
$ No Bid
C-2
No. 53 Gravel
1000
TON
No Bid
$ No Bid
C-3
No. 53 Recycled Concrete
7500
TON
No Bid
$ No Bid
C-4
No. 53 Slag
1000
TON
No Bid
$ No Bid
C-5
Topsoil
150
CY
No Bid
$ No Bid
C-6
No. 11 Slag Chip Stone
1000
TON
No Bid
$ No Bid
DIVISION C TOTAL
$ No Bid
DIVISION D - SEWER MATERIALS - CASTINGS
Item
No.
Description
Quantity
Unit
Unit Price
Total
Manhole Cover and Frame:
D-1
EJ 1040A or Neenah R-1642
300
EA
No Bid
$ No Bid
(Circle One)
Catch Basin Cover & Frame:
D-2
EJ 1020-M1 or Neenah R-
300
EA
No Bid
$ No Bid
1642 (Circle One)
DIVISION D TOTAL
$ No Bid
Version 01/29/2020 Contractor's Bid for Public Works - 9
12101:4-116 022
BID/PROPOSAL
CITY OF SOUTH BEND
2020 Street and Sewer Department Materials
April 14, 2020, 9:30 a.m., Local Time
DIVISION E - SEWER MATERIALS
Item
No.
Description
Quantity Unit
Unit Price
Total
E-1
MH Riser 20 3/4" D — 1 "R — 7/8"L
40
EA
No Bid
$ No Bid
E-2
MH Riser 20 3/4" D —1 1/2"R — 7/81
40
EA
No Bid
$ No Bid
E-3
MH Riser 20 3/4" D — 2"R — 7/8"L
20
EA
No Bid
$ No Bid
E-4
MH Riser 20 3/4" D — 2 1/2"R — 7/8"L
10
EA
No Bid
$ No Bid
E-5
MH Riser 21 3/4" D — 1 "R — 1 3/8"L
20
EA
No Bid
$ No Bid
E-6
MH Riser 21 3/4" D — 1 1/2"R — 1
3/8"L
30
EA
No Bid
$ No Bid
E-7
MH Riser 21 3/4" D — 2"R — 1 3/8"L
30
EA
No Bid
$ No Bid
E-8
MH Riser 22 1/8" D — 2"R — 1 1/4"L
20
EA
No Bid
$ No Bid
E-9
MH Riser 22 1/8" D — 3"R — 1 1/4"L
5
EA
No Bid
$ No Bid
E-1 0
MH Riser 22 1/4" D — 1 "R —1 1/2"L
30
EA
No Bid
$ No Bid
E-1 1
MH Riser 22 1/4" D — 1 1/2"R — 1
1/2"L
30
EA
No Bid
$ No Bid
E-12
MH Riser 23" D — I "R — 1 3/4"L
30
EA
No Bid
$ No Bid
E-13
MH Riser 23" D —1 1/2"R —1 3/41
20
EA
No Bid
$ No Bid
Version 01/29/2020 Contractor's Bid for Public Works - 10
BID NAME
FOR BIDS DUE
BID/PROPOSAL
CITY OF SOUTH BEND
2020 Street and Sewer Department Materials
April 14. 2020. 9:30 a.m., Local Time
DIVISION E - SEWER MATERIALS CONTINUED
Item
No.
Description
Quantity
Unit
Unit Price
Total
E-14
MH Riser 23" D — 2"R — 1 3/4"L
40
EA
No Bid
$ No Bid
E-1 5
MH Riser 23 5/8" D — 1 1/2"R — 1
10
EA
No Bid
$
1/8"L
No Bid
E-16
MH Riser 23 5/8" D — 2"R —1 1/8"L
10
EA
No Bid
$ No Bid
E-17
MH Riser 23 5/8" D — 1"R —1 1/2"L
20
EA
No Bid
$ No Bid
E-1 8
MH Riser 23 5/8" D — 1 1/2"R — 1
25
EA
No Bid
$ No Bid
1/2"L
E-19
MH Riser 23 5/8" D — 2"R — 1 1/2"L
20
EA
No Bid
$ No Bid
MH Riser 23 5/8" D — 2 1/2"R — 1
E-20
1/21
20
EA
No Bid
$ No Bid
DIVISION E TOTAL
$ No Bid
DIVISION F - TRAFFIC MATERIALS
Item
No.
Description
Quantity
Unit
Unit Price
Total
F-1
Liquid Thermoplastic Traffic
2200
GAL
No Bid
$ No Bid
Marking Paint — White
F-2
Liquid Thermoplastic Traffic
2200
GAL
No Bid
$
Marking Paint —Yellow
No Bid
F-3
Pavement Marking Beads,
40000
LBS
No Bid
$ No Bid
Standard
DIVISION F TOTAL
$ No Bid
Version 01/29/2020 Contractor's Bid for Public Works - 11
BID NAME
FOR BIDS DUE
BID/PROPOSAL
CITY OF SOUTH BEND
2020 Street and Sewer Department Materials
April 14, 2020, 9:30 a.m., Local Time
DIVISION G - SNOW REMOVAL MATERIALS
Item
No.
Description
Quantity Unit
Unit Price
Total
Curved Double Bevel Carbon
G-1
Steel Underbody Blade 51 x 67 x
300
EA
No Bid
$ No Bid
5/8"Th
Curved Single Bevel Carbon Steel
G-2
Underbody Blade 51 x 6"T x
50
EA
No Bid
$ No Bid
3/4"Th Heat Treated — Hardened
Curved Single Bevel Carbon Steel
G-3
Underbody Blade 61 x 67 x
50
EA
No Bid
$ No Bid
3/4"Th Heat Treated — Hardened
Boss Power V Plow Blade 51" X 6"
G-4
X '/a' Part # BAL08858 Passenger
6
EA
No Bid
$ No Bid
Side Edge
Boss Power V Plow Blade 51" X 6"
G-5
X'/2" Part # BAL08859 Drivers
6
EA
No Bid
$ No Bid
Side Edge
G-6
8' 6" Western MVP Plus Plow
6
EA
$
Blade Part # 44285-1
No Bid
No Bid
G 7
Western Pro Plus Plow Blades
8
EA
No Bid
$ No Bid
90"L x 6"T x 1 /2"Th
DIVISION G TOTAL
$ No Bid
Version 01/29/2020 Contractor's Bid for Public Works - 12
BID NAME
FOR BIDS DUE
BID/PROPOSAL
CITY OF SOUTH BEND
2020 Street and Sewer Department Materials
April 14, 2020, 9:30 a.m., Local Time
DIVISION H - ASPHALT MATERIALS CONT'D
Item
No.
Description
Quantity
Unit
Unit Price
Total
H-1
AE-T Tack
25,000
GAL
No Bid
$ No Bid
H-2
RS-2
25,000
GAL
No Bid
$ No Bid
DIVISION H TOTAL
$ No Bid
DIVISION I - DELIVERY OF HMA MATERIALS BY TRI-AXLE TRUCK
Item
No.
Description
Quantity
Unit
Unit Price
Total
1-1
Driver and Truck
600
PER HR
No Bid
$ No Bid
DIVISION I TOTAL
$ No Bid
Bidder (Firm):
Address:
City/State/Zip:
Ozinga Ready Mix Concrete, Inc.
715 W. Ireland Road
South Bend, IN 46614
Telephone Number: 574 ) 291-7100
By
(Signature)
Scott Underwood
(Printed Name of Person Signing)
Version 01/29/2020 Contractor's Bid for Public Works - 13
Document A310 TM - 2010
Conforms with The American Institute of Architects AIA Document 310
Bid Bond
CONTRACTOR:
(Name, legal status and address)
Ozinga Ready Mix Concrete, Inc
715 W. Ireland Road
South Bend, IN 46614
OWNER:
(Nance, legal statits and address)
City of South Bend Board of Public Works
227 West Jefferson
South Bend, IN 46601
SURETY:
(Name, legal status and inineipal place rfhtainess)
Western Surety Company
151 N. Franklin Street
Chicago, IL 60606
Mailing Address for Notices
151 N. Franklin Street
Chicago, IL 60606
BOND AMOUNT: 5% Five Percent of Amount Bid
PROJECT:
(,'Vance, location or address and Project number, if a)r}
2020 Street and Sewer Department Materials Project #120-005
This document has important
legal consequences. Consultation
with an attorney is encouraged
with respect to its completion or
modification.
Any singular reference to
Contractor, Surety, Owner or
other party shall be considered
plural where applicable.
The Contractor and Surety are bound to the Owner in the amount set forth above, for the payment of which the Contractor and Surety bind
themselves, their heirs, executors, administrators, successors and assigns, jointlyand severally, as provided herein. The conditions of this
Bond are such that if the Owner accepts the bid of the Contractor within the time specified in the bid documents, or within such time period
as may be agreed to by the Owwner and Contractor, and the Contractor either (I) enters into a contract with the Owner in accordance with
the ternis of such bid, and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a surety admitted in
the jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contract and for the prompt
payment of labor and material furnished in the prosecution thereof; or (2) pays to the Owner the difference, not to exceed the amount of
this Bond, between the amount specified its said bid and such larger aniount for which the Owner may in good faith contract with another
party to perlbrin the work cowered by said bid, then this obligation shall be null and void, otherwise to remain in 1611 lorce and eil'ect. The
Surety hereby waives any notice of an agreement between the Owner and Contractor to extend the time in which the Owner may accept the
bid. Waiver oI*no lice by the Surety shall not apply to any extension exceeding sixty (00) days in the aggregate beyond the tinie for
acceptance ni' bids specified in the bid documents, and tine Owner and Contractor shall obtain the Surety s consent tier an extension beyond
sixty (60) days.
If this Bond is issued in connection witli a subcontractor's bid to a Contractor, the teen Contractor in this Bond shall be deemed to be
Subcontractor and the term Owner shall be deemed to be Contractor.
When this Bond has been lirniished to comply with a statutory or other legal requirement in the location of the project, any provision in
this Bond conflicting iiith said statutory or legal requirement shall be deemed deleted hereliom and provisions coiiliirniing to such
statutory or other legal requirement shall be deemed incorporated herein. When so lumished, the intent is that this Bond shall be construed
as a statutory blind and not as a common law bond.
Signed and scaled this 14th day of April, 2020.
tlVirness)
(Wirnesv) Donna Planeta
S-00541AS 8110
Ozinga Ready Mix Concrete, Inc.
tPtincipal) (seal)
6:
(Title)
Syj6gitpig110(^SppN,.
Western Surety Company
By
TW: 'fix
rya Nguyen Attorney -in -Fact
Western Surety Company
PO«%ER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT
Know All Men By These Presents, That WESTERN SURETY COMPANY, a South Dakota corporation, is a duly organized and existing corporation
having its principal office in the City of Sioux Falls, and State of South Dakota, and that it does by virtue of the signature and seal herein affixed hereby
make, constitute and appoint
Tanya Nguyen , Individually
of Chicago, IL its true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred to sign, seal and execute for and on its behalf
bonds, undertakings and other obligatory instruments of similar nature
- .In Unlimited Amounts -
Surety Bond No.: Bid Bond
Principal: Ozinga Ready Mix Concrete, Inc.
Obligee: City of South Bend Board of Public Works
and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said
Attorney, pursuant to the authority hereby given, are hereby ratified and confirmed.
This Power of Attorney is made and executed pursuant to and by authority of the By -Law printed on the reverse hereof, duly adopted, as indicated, by
the shareholders of the corporation.
In Witness Wbereof, WESTERN SURETY COMPANY has caused these presents to be signed by its Vice President and its corporate seal to be
hereto affixed on this 27th day of February, 2018.
„.n»»w111 WESTERN SURETY COMPANY
�a4tETYCP
�wQt`Q,40gq +ib
z
7yf SCAvp
°a�T%� ppNd
w»» Paul T. Bruflat, Vice President
State of South Dakota I
S$
County of Minnehaha
On this 27th day of February, 2018, before me personally came Paul T. Bruflat, to me known, who, being by me duly sworn, did depose and say: that
he resides in the City of Sioux Falls, State of South Dakota; that he is the Vice President of WESTERN SURETY COMPANY described in and which
executed the above instrument; that he knows the seal of said corporation; that the seal affixed to the said instrument is such corporate seal; that it was so
affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority, and
acknowledges same to be the act and deed of said corporation.
My commission expires d. MOHR
�^
June 23, 2021IV
J. Mohr, Notary Public
CERTIFICATE
I, L. Nelson, Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in
force, and further certify that the By -Law of the corporation printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed
my name and affixed the seal of the said corporation this 14th day of April, 2020.
�S�RETy"w, WESTERN SURETY COMPANY
. ,y� ,,........... ('ems
� x
wwQGTk DAB;
4171sn, Assistant Secretary
Form F4280-7-2012
Go to www.cnasurely. com > Owner / Obligee Services > Validate Bond Coverage, if you want to verify bond authenticity.
Authorizing By -Lace
ADOPTED BY THE SHAREHOLDERS OF WESTERN SURETY COMPANY
This Power of Attorney is made and executed pursuant to and by authority of the following By -Law duly adopted by the shareholders
of the Company.
Section 7. All bonds, policies, undertakings, Powers of Attorney, or other obligations of the corporation shall be executed in the
corporate name of the Company by the President, Secretary, and Assistant Secretary, Treasurer, or any Vice President, or by such other
officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer
may appoint Attorneys in. Fact or agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company.
The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the
corporation. The signature of any such officer and the corporate seal may be printed by facsimile.
1316 COUN'i-Y-0i'y BuiLDING ' PHONE 574/235-9251
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227 W. JEFFERSON Boui,EVARD U W�H FAX 574/235-9171
SOUTH BEND, INDIANA 46601-1830 4 TDD 574/235-5567
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CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR
BOARD OF PUBLIC WORKS
Date: April 6, 2020
To: All Planholders
From Linda M. Martin, Clerk, Board of Public Works
Subject Addendum Number: I
Project Name: 2020 Street and Sewer Department Materials
Project No.: 120-005
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.
Notes:
The attached documents are hereby added to the Specifications and Contract
Documents and become a part of herein.
Company:
Authorized Signature:
Date: 411900