HomeMy WebLinkAboutOpening of Bids - 2020 Street & Sewer Materials Proj No. 120-005 - Walsh & Kelly, Inc.iyTUI
LI � !.
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
CHECKLIST FOR BIDDERS
Project Name 2020 Street and Sewer Department Materials
Project No. 120-005
For Bids Due April 14, 2020, 9:30 a.m., Local Time
From time to time the South Bend Board of Public Works finds it necessary to reject a bid because
it does not comply with statutory requirements. In preparing your bid, please use the following
checklist in order to make sure that your bid is done in the proper manner.
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.
Acknowledge Receipt of 1 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
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 andl,ecmiply with the specifications.
Bidder: Walsh & Kelly, Inc.
By Authorized
Signature:
Print Name & Titl
Version 01/29/2020 Contractor's Bid for Public Works - 1
Date: 4/14/20
`�`ltitltTt®r��
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INM
1101111000
Project No. 120-005
For lde ue April 1 g 2020, 9m30 a.m., Local Time
PART I
(Must be completed for all bids. Please -type or print.)
Date: 4/14/20 Bidder (Firm): _ Walsh , Kell Inc..
Address: 2435E SIR 2
City/State/Zip: S.o.u.1th Bend „ Telephone Number f, 5,74 J....... -4 1.1.............. �..................................................... .
Agent of Bidder (if Applicable): _
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete �the
public Works project of:
020 Street and Sewer Deoart ent Materials
the City of South Bend, Indiana, in accordance With plans and specifications prepared by:
Board of Public orks......Division of nglneerin
and dated March 2020 for the sum of (enter the Total Bid as shoran on the Proposal)
One Million fight hundred sixty five thousand Eve hundred dollars and zero cents
. .
(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 addendums attached will be specifically referenced at the applicable page.
111
If additional units of material included in the contract are ne d, te'6os ° units must be the same as that
shown in the original contract if accepted by the City of��uth .Bnd. Vt' re bid is to be awarded on a un
basis, the itemization of the units shall be shown on a Iep r e at ent. ``�VELLY0 -1,�
e �
— ««.w®®®® �.
y
(Signature) 0 10
Dustin FIIaI gVFof,South Bend Ar
..
(Printed Name of Person Signing)
ACCEPTANCE °-
« Z
« ti
The above bid is accepted this day of VV
Subject to the following conditions -------- -------- --- ---- f1%01r it w0%
Gary A. Gilot, President Joseph R. Molnar, Member
Elizabeth A. Maradik, Member Therese J. Dorau, Member
Jordan V. Gathers, Member Attest: Linda M. Martin, Clerk
Version 01/29/2020 Contractor's Bid for Public Works - 2
PART !1
(For projects of $100,000 or more — IC 36-1-124)
These statements to be submitted under oath by each bidder with and as part of his/her/its bid.
Attach additional pages for each section as needed.
SECTION I EXPERIENCE QUESTIONNAIRE
1. Attach information regarding projects your organization has completed for the period of one
(1) year prior to the date of the current bid.
2. Attach a listing of public works projects currently in process of construction by your
organization.
3. Attach information regarding any failure to complete any work awarded to you and the
location thereof.
4. Attach references from private firms for which you have performed work.
SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE
1. Attach an explanation of your plan or layout for performing proposed work. (Examples could
include a narrative of when you could begin work, complete the project, number of workers,
etc. and any other information which you believe would enable the City of South Bend to
consider your bid.)
2. Attach a listing of the names and addresses of all subcontractors (i.e. persons or firms outside
your own firm who have performed part of the work) that you have used on public works
projects during the past five (5) years along with a brief description of the work done by each
subcontractor.
3. If you intend to sublet any portion of the work, attach the name and address of each
subcontractor, equipment to be used by the subcontractor, and whether you will require a
bond. However, if you are unable to currently provide a listing, please understand a listing
must be provided prior to contract approval. Until the completion of the proposed project, you
are under a continuing obligation to immediately notify the City of South Bend in the event that
you subsequently determine that you will use a subcontractor on the proposed project.
4. Attach a listing of equipment you have available to use for the proposed project.
5. Have you entered into contracts or received offers for all materials which substantiate the
prices used in preparing your proposal? If not, attach an explanation for the rationale used
which would corroborate the prices listed.
SECTION III CONTRACTOR'S FINANCIAL STATEMENT
Attachment of bidder's financial statement is mandatory. Any bid submitted without said
financial statement as required by statute shall thereby be rendered invalid. The financial
statement provided hereunder to the City of South Bend awarding the contract must be specific
enough in detail so that said City of South Bend can make a proper determination of the bidder's
capability for completing the project if awarded.
Version 01/29/2020 Contractor's Bid for Public Works - 3
When theprospective Contractor is unable to certify to any of the statenwnts below, itshall attach an explanation to this Affida pit
CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION
RE GARDING INVEnMENT WITHIRAN,EMPLOYMENT ELIGIMLETY 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 Illndilaina
) SS:
St, JOSeP,�, COLYNTY
___ . . . .......................
Tbe undersigned Contractor, being duly sworn upon his/fier/its oath, affirms under the penalties of perjury
that::
1. Contractor has not, nor has any other member, representative, or agent of the finn, company,
corporation. or partnership represented by hini, entered into any combination, collusion or agreement with
any pet -son 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 agreernent, 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 arny. of its principals
are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded fioni
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 govern ment of Iran and any agency
or instrumentality of Iran., or as otherwise defined at Ind. Code § 5-2246.5-5, as
amended ftom time -to. -time..
b. As provided by Ind. Code § 5-22-.16.5-8, as ainendedfirom three -to -brae, 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 energ
.,y sector of Iran;
or
H. 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, iftliat person will (i) us.e glee credit to provides
goods and services in the, energy sector in Iran, and. (ii) at the time tile
Financial institution extends credit, is a person identified on list published by
tile Indiana Department of Administration,
Version 01/2912020 Contractor's INd for IPuulbllic 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 airMWBE;
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.
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).1 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
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 141h day of ,April„ 2020
re of Contractor/Bidder or Its agent
Printed Narne and 'Title
Subscribed and swornto before me this 14th day of _.__April........._.._____ 20w2O,,.
My Commission Expires 6/5/22
Notary PuM2 6 Allsha Kra ger
County of Residence St. Joseph „
v w.„.:. wwa ,a wvw.w.wmw�mma�'Ww �wvwrl�w.iwwwrmvw�r ; ��mww�u^.varww7wixw:arx
ALISHA KRUEGER
;..
Notary Public, Mate of Indiana
3t. Joseph County
My Commission Expires
JunF05 2022
.MOW& 'W%
Version 01/29/2020 Contractor's Bid for Public Works - 6
BID/PROPOSALa�
CITY OF SOUTH BEND
BID NAME 2020 Street and Sewer Department Materials
R-
FOR BIDS DUE April 14, 2020, 9:30 a.m., Local Time
DIVISION
A - ASPHALT MATERIALS
...................
- . . . ...._ .............. .w
Item No.
Description
Quantity
Unit
Unit Price
Total
A-1
HMA Surface 11 L
15000
TON
$ 57.00
$ 855,000.00
A-2
HMA Surface 11 L MAC HD
5000
TON
$ 58.00
$ 290,000.00
A-3
HMA Surface 11 S
2000
TON
$ 57.00
$ 114,000.00
................
A-4
. .............
HMA Binder 8/9
1500
TON
$ 37.00
$ 55,500.00
A-5
HMA Binder 11
3000
TON
$ 49.00
$ 147,000.00
A-6
. .......
HMA Binder 11 MAC
1000
TON
$ 50.00-
$ 50,000.00
A-7
HMA Base 5D
................
1000
TON
$ 37.00
$- 37-600.00
A-8
CMA Patch AE-300P
500
TON _
$ 65.00
$ 32,500.00
A-9
............................
High Performance Cold Mix
150
EA
$ 95.00
...............
$ 14,250.00
�.
.. _............
DIVISION A TOTAL
$ 1,595,250.00
DIVISION
B - PCC MATERIALS
Item No.
Description
Quantity
Unit
Unit Price
Total
B-1
Class A Concrete
2500
CY
No Bid
No Bid
B-2
Class A High Early
800
CY
No Bid
No Bid
B-3
7 Bag Mix - New City Specs
600
CY
No Bid
No Bid
B-4
High Early Concrete w/ Integral Color -
350
CY
No Bid
No Bid'
Black
B-5
Plowable Fill, Removable
350
CY
No Bid
No Bld
B-6
Non -Chloride Accelerator added to
325
EA CY
No Bid
No Bid
concrete — 0.5%
B-7
Non -Chloride Accelerator added to
1000
EA CY -.
mmmmmITITITITITITITITITITIT No Bid
No Bid
concrete — 1 %
B-8
Non -Chloride Accelerator added to
2100
EA CY
No Bid
No Bid
concrete — 2%
-. _ _... �................
DIVISION B TOTAL
No Bid
DIVISION
C - AGGREGA-rE MATERIALS
Item No.
Description
Quaintrity
Unit
Unit Price
Total
-- ----
No., 23 Sand
-5006
IFON
$
11.50$.-
57,500.00
C-2
. ...............
No. 53 Graven1000
TON
$
14.00
$.....__
.......... --
--]
14,000.00
C-3
No. 53 Recycled Concrete
7500
- ------- .
TON
. . ........................
$
11.00
$
82,500.00
C-4
. ......
No. 53 Slag
1000
TON
$
16.50
$
16,500.00
C-5
Topsoil
150
CY
$
25.00
$
3,750.00
C-6--
. . . . ................ .. .. .. . . . . .. .. .
No., 11 Slag Chiip Stone
1000
TON
$
21.00
$
21,000.00
. ....................
DIVISION C TOTAL
$
195,250.00
DIVISION
D - SEWER MATERIALS - CASTINGS
. .................................... ............... ................ ... . . ..........
. . .........
. . ...................
.
. . . . .......................
. . . . . . .
Item No.
Description
Quantity
Unit
Unit Price
Total
D-1
Manhole Cover and Frame: EJ
300
EA
No Bid
No Bid
1040A or Neenah R-1642 (Circle
One)
D-2
Catch Basin Cover & Frame: EJ
300
EA
No Bid'
No Bid
1020-M1 or Neenah R- 1642
(Circle One)
.
.........................
DIVISION D TOTAL
No Bid
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 - 7/8"L
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
w--
20
EA
No Bid
No Bid
.......
E-6
MH Riser 21 3/4" D - 1 1/2"R - 1
30
EA
No Bid
No Bid
3/8"L
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-10
MH Riser 22 1 /4" D - 1"R - 1 1/2"L _
30
EA
No Bid
No Bid
E-11
MH Riser 22 1/4" D - 1 1/2"R - 1
30
EA
No Bid
No Bld.
1/2"L
E-12
MH Riser 23" D -1 "R -1 3/4"L
30
EA
No Bid
--__..................
No Bid
E-13
_.............
MH Riser 23" D -1 1 /2"R - 1 3/4"L
20
EA
No Bid
No Bid
DIVISION
E -SEWER MATERIALS CONTINUED
Item No.
Description
Quantity
Unit
Unit Price
Total
`MH —Riser 23- D - 2"R - I 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
No Bid
1/8"L
E-16
MH Riser 23 5/8" D - 2"R - 1 1/8"L
10
EA
No Bid
No Bid
E-1 7
........... . . . . ......... . .......
MH Riser 23 5/8" D - 1 "R - 1 1/2"L
20
EA
No Bid
No Bid
E-18
MH Riser 23 5/8" D - 1 1/2"R - 1
25
EA
.
No Bid
. . . . ......................
No Bid
1/2"L
E-1 9
MH Riser 23 5/8" D - 2"R - I 1/2"L
20
EA
...... . ......................... .
No Bid
No Bid
E-20
MH Riser 23 5/W b i "R 1
..... .
EA
. . ..... . ......... . . . ..................... .. ........
No Bid
No Bid
1/2"L
71
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
..............
2_200 . .....GAL
No Bid
No Bid
Marking Paint - Yellow
F-3
Pavement Marking Beads,
466-0-0-
LBS
No Bid
No Bid
Standard
DIVISION F TOTAL
No Bid
DIVISION
G SNOW REMOVAL MATEIRIAll...,S
Train No
''' Description
Quantity
Unit
Unit PIrII
Dotal
G I
�. _ ........
Gury d IDoublle Bevel Carbon Sty l
360
A
No laud
-.......�
No Bird'
U nderbody If:illade 5"II... x 6"T x 5/8"Th
G-2
Curved Single Bevel Carbon Stull
50
If::A
No Biid
No Bid
U nderlbody Made 51... x 6"T x 3/4"TKO
Heat Treated — Hardened
G-3
Curved Siirngle Bovell Carbon Stool
50
EA
No Bid
No Bid i
Underlbody Made 61...x 6"T x 3/4,,"rh
Heat Treated ...... Hardened
4
.....�...................................w.w...w.............,.. .....r
Boss Po�ror �/ Blow- Bla.do 5t "" X
+.r. .......nrrmrry
6
....,,e,...... .
If:::A
...............,..�..�..�.....
No Bid
..www.d. _.._ ..............
No Bid
Flart # BAI...66658 Passenger Side Edge
G.5
Boss Po er V 1:11low Blade 51'
6
I.: A
No Bud
No Bid
Part # BAIl...96659 Drivers Side Edge
G-6
3" 6" Western VP Mu s Flour Blade
6
EA
No Bid
No Bid
D'art # 44285-1
G.4
Western Pro Plus Row Blades 90"L x
3 m
If.::A
mmIT No laid
No Bid
6"T x t /2"°Th
.
_........ .
DIVISION G TOTAL
No Bid
DIVISION
H - ASPHAt r MATERIALS
CONT'D
—Tlt—eim
Description
..................... . ..........................
Quantity,
. ..... --------
Unit
Unit Price
. ......
Total
No.
H-1
AE-T "rack
25,000
GAII
No Bid
No Bid
H.-.2
RS-2
..............
25,000
. ... ............ - I
-43A—L
No Bid
-- . ..... . . . .............. . . ...... —K-o —Bid:
.... ........... .................
. . . .
..
.................. . .
DIVISION H TOTAL
No Bid�
DIVISION
......................... . — . . . .............. . . . .............................
I - DELIVERY OF HMA MATERIALS BY TRI-AXLE TRUCK
..........
Item
Description
Quantity
Unit
—
Unit Price
— — - - — - - - ----------------------..___-
Total
No.
—Truck
1-1
Driver and
66-0—
PER HR— $12-5.00
—
$ 7 1 5,000.00
. . ................... . . . . --1-
. . . . ............................ .
..................
.
..................... . .
DIVISION I TOTAL
...... ............
$ 75,000.00
Bidder §,h & Inc.
City/State/� out d IN 614
wwwwwwwwwww
By
(Signature)
Dustin Hilary, VP of South Bend Area
(Printed Name of Person Signing)
Address: 24358 SR 23
Telephone Number: _L574 )_288-4811
I I i I I I jJ0 .4
y,ELL)- Iflo,
Ilk
C)RAT4, %
C H U B B" Surety O +908.903.3485
202B Halls Mill Road, PO Box 1650 F + 908.903.3656
Whitehouse Station, NJ 08889-1650
Federal Insurance Company
AIA Document A31OTM - 2010 Bid Bond
Anysingular reference to Contractor, Surety, Ovvner or other party shill he considered plural where applicable.
CONTRACTOR
(Name, legal status and address):
Walsh & Kelly, Inc.
24358 State Road 23
South Bend, IN 46614
OWNER
(Name, Iegal status and address):
City of South Bend, Indiana, Board of Public Works
227 W. Jefferson Boulevard
South Bend, IN 46601
BOND AMOUNT 5% Five Percent of the Total Bid
PROJECT
(Name, location or address, and project number, if any)
SURETY
(Name, legal status and principal place of business):
Federal Insurance Company
202B Halls Mill Rd., PO Box 1650
Whitehouse Station, iQ 08889-1650
2020 Street and Sewer Department Materials, Project No. 120-005
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, jointly and
severally, as provided herein. The conditions of this Bond are such that if the Owner accepts the bid of the Contractor
within the time specified in the bid documents, or within such time period as may be agreed to by the Owner and
Contractor, and the Contractor either (1) enters into a contract with the Owner in accordance with the terms of such
bid, and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a surety admitted
in the jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful 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 in said bid and such larger amount
for which the Owner may in good faith contract with another party to perform the work covered by said bid, then this
obligation shall be null and void, otherwise to remain in full force and effect. The Surety hereby waives any notice of
an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver
of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for
acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for
an extension beyond sixty (60) days.
If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall
be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor.
Printed in cooperation with the American Institute of Architects (ALA) by Chubb. The language in this document conforms to the language used in
AIA DocumentA310 m-2010.
Form 15-02-0575-FED (Rev. 3/17)
Whenthis Bondhasbeen furnishedto complywith a statutory or other legal requirement in thelocation ofthe Project,
any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted here
from and provisions conforming to such statutory or other legal requirement shall be deenied incorporated herein.
When so furnished, the intent is that this Bond shall be construed as a statutory bond and not as a common law
bond.
Signed and sealed this 14th
(Witness) Alisha Krueger, Administrative A 4-Istant
'A
- �ffl
(Witness) Anna C. Oliger, Administrative Assistant
day of April, 2020
Walsh & lKeYy',Aq,a
tin Hil Vice Pr ent:
(Title)
C-i .1 ®�
® VORATF
a
Aw
oww
Federal Insurance Company
(Attorney -in Fact) David lM.911"ger
zAN V
(QRO,rateSeal)�
Printed in cooperation with the American Institute of Architects (ALA) by Chubb. The language in this document conforms to the language used in
AM DocumentA310 7m-2010.
Form 15-02-0575-FED (Rev. 3/17)
f
,COMPANY, a Wisconsin corporation, WESTCHESTER FIRE INSIU NCE COMPANY and ACE AMERICAN INSURANCE COMPANY corporations of the Commonwealth of
Surety Bond Number: Bid Bond
bllgee: City of South Bend, Indiana, Board of Public Works
each as their true and lawful Attorney-m-Fact to execute under such designation In their names and to affix their corporate seals to and deliver for and on their behalf as surety
thereon or otherwise, bonds and undertakings and other writings obligatory in the nature thereof (other than ball bonds) given or executed in the course ofmisiness, and any
instruments amending or altering the same, and consents to the modification or alteration of any Instomment referred to in said bonds or obligations.
In Witness Whereof, said FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, PACIFIC INDEMNITY COMPANY, WESTCHESTER FIRE INSURANCE COMPANY
and ACE AMERICAN INSURANCE COKPANY have each executed and attested these presents and affixed their corporate seats on this lot day of No her, 2019.
Dawn M. Chloros, Assistant Secretary
STATE OF NEW JERSEY
County of flunterdon SS.
On this 1d day of November, 2019, before one, a Notary Public of New Jersey, personally came Dawn M. Chloros and Stephen M. Raney, to one known to be Assistant Secretary and
Vice President, respectively, of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, PACIFIC INDEMNITY COMPANY, WESTCHESTER FIRE INSURANCE COMPANY
and ACE AMERICAN INSURANCE COMPANY, the companies which executed the foregoing Power ofAttorney, and the said Dawn M. Chloros and Stephen M. Raney, being by me duly
sworn, severally and each for herself and himself did depose and say that they are Assistant Secretary and Vice President, respectively, of FEDERAL INSURANCE COMPANY,
VIGILANT INSURANCE COMPANY, PACIFIC INDEMNITY COMPANY, WESTCHESTER FIRE INSURANCE COMPANY and ACE AMERICAN INSURANCE COMPANY and know the
corporate seals thereof, that the seals affixed to the foregoing Power of Attorney are such corporate seals and were thereto affixed by authority of said Companies; and that their
signatures as such officers were duly affixed and subscribed by like authority.
ai
NOTARY PUBUO OF NEMIJERMY
Na 2316aw
r
COMPANY and ACE AMERICAN INSURANCE COMPANY (the'Conspardes') do hereby certify that
(I) the foregoing Resolutions adopted by the Board of Directors of the Companies are true, correct and in full force and effect,
(9) the foregoing Power of Attorney Is true, correct and In full force and effects
Given under my hand and seats of said Companies at Whitehouse Station, NJ, this April 14, 2020.
h)Pn�r
2.
w �' �"eP age n ) r° t Dawn M. Chloros, Assistant Secretary
._._... _.......... WW .....�„ .1`ed lh®ne99oeI903®�33 �ma�F , 9„O�p, 03 3656 � ,ma[I: Sur �Fl67`f6E,PL ......E CC IfSAT':
IN THE YOU WISH TO VERIFYTHE A ENTICITI �FTFI[S i3t1ND �ft Nt71 [FYUS ®F I{E IT
Coaobl : FED-VIG-ICI- iC iC ( . 11-19)
Part of State FormS2414 (R2 / 2-13) Form 96 (Revised 2013)
Walsh & Kell, Inc.
(Contractor)
(Address)
South Bend IN 46614
FOR
PUBLIC WORKS PROJECTS
OF
Cit of South Bend Indiana
2020 Street and Sewer De artment Materials
Project No, 120-005
Filed Aril 14th, 2020
Action taken
State Form 52414 (R / 9-10)
P[ejrmbqd day State Bgarrl_q r—SounlLi .. .. ______.. ..... _ Form N . 96 R is 0
CONTRACTOR'S BID FOR PUBLIC WORK — FORM 96
PART 1
(To be completed for all bids. Please type or print)
Date (month, day, year): Apri11W14,.2020
1. Governmental Unit (Owner): City of South Bend, Indiana
2. County: St. Joseph
3. Bidder (Firm):
Address:
City/State:
4. Telephone Number:
5. Agent of Bidder (If applicable):
Walsh-4-Kelly,-Inc . .
24358 SR2.3. ,,,...
South Bend, IN 46614„ww ee
(574') 288-4811
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the public
works project of City of South Bend, Indiana — Board of Public Works and Safety (Governmental Unit) in
accordance with plans and specifications prepared by Department of Public Works — Division of Engineering
and dated March 2020 for the sum of See Attached See Attached.
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. I hereby certify 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.
ACCEPTANCE
The above bid is accepted this day of _ subject to the following conditions:
Contracting Authority Members:
PART II
(For projects of $150,000 or more —IC 36-1-12-4)
Governmental Unit: City of South Bend, Indiana
Bidder (Firm): Walsh & Kelly, Inc.
Date(month, day, year)
These statements to be submitted under oath by each bidder with and as part of his bid. Attach additional pages
for each section as needed.
SECTION I EXPERIENCE QUESTIONNAIRE
Have you ever failed to complete any work awarded to you? No If so, where and why?
5. List references from private firms for which you have performed work.
Gatlin Plumbing,. & Heating, Inc. l I I I E. Main St..;.Griffith, IN Ms. Clara Murrl by,
.... .....
Gough Inc 2200_E. 88" Dr.. Merrillville, IN 464.1.0 Mr.....Ra Raymond Gough
................................... ............. -
Dyer Construction Co , _1716 Sheffield Avenue,.. Dver, IN --_Janet Furman _
Grimmer..Construction,,,Co , Inc. 2619.Main .Street, HI hland IN.mmMr. Grua Grammer ,,,
SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE
1. Explain your plan or layout for performing proposed work. (Examples could include a narrative of when you could
begin work, completed the project, number of workers, etc. and any other information which you believe would
enable the governmental unit consider your bid.)
As required by owner
2. 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.
See Attached List
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.
Will supply upon award of contract
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.
QUANTITY
ITEM
DESCRIPTION,
CONDITION YEARS
PRESENT LOCATION
SIZE, CAPACITY,
OF
...... m
ETC
SERVICE
Asphalt Plants
Various
Good
Griffith, South Bend,
— _
Valparaiso, Lowell LaPorte
_...Asphalt Pavers.......
Various �....... ........
Good
�m,,,,.,.,,,,,,,,.
Griffith, South Bend 1
----- - ----
...................................19
4
Slipform Conc. Paver
Various
Good
Griffith, South Bend
3
Road Widener
Various
Good
Grtfl7th South Bend I
5
......
Motor Graders
CAT/J.D. D
Good
Griffith, South Bend
54
Rollers
Various
Good
Griffith, South Bend
30
Rubber Tire Loaders
.. --
Various
Good
Griffith, South Bend
...........___...._
15
Excavators
Various
Good
Griffith, South B end
9
Bulldozers
zers
arlous
_ _..
ood.�
Griffith South Bend
Griffith, ..
6
LowBov Tractors
_ _ _
Various
Goo .
Griffith, South Bend
8
Flatbed Dumb s
Various ----
Good I ....
Griffith, South Bend
...... ..
48
..._
'/z and .
�.
...... .... .. .......... -
------- -- _.... ._..._.__
65
.
1 Ton Crew_ _ Trucks
Various
Good
Griffith, South Bend
..........................................................
3
Cold Planers
Wirtgen 1900
Good
od
Griffith, South Bend
DC
3
TrI Axle Dum
Mack
Good
South Bend
5. Have you entered
into contracts or received
offers for all materials
which substantiate
the prices used in preparing
your proposal?
Otherwise, please explain
the rationale used
which would corroborate
the prices listed.
Yes, we received
quotes from potential
subcontractors and suppliers
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.1hereunder to the governing body awarding
the contract must be specific enough in detail so that said governing body can make a proper deten-nination ofthe bidder's
capability for completing the project if awarded.
SECIIONIV CONTRACTOR'S NON CO.I....LUSIONAFF1.11 )ANT.1'
11le undersigned bidder or agent, being duly sworn on oath, says that lee has not, nor :has any other inernber,
representative, or agent of the firin, company, corporation or partnersliip 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 torefrain from bidding, and that this bid is made without reference to any other bid and
without any apreement, understanding or corn1bination with any other person in reference to such bidding.
Ile 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
s.EcriON V 0A.111. AND AFFIRMATION
I HEREBY AFFIRM UNDERTHE PENALTIES FOR PERAJKYTHATTFIE FACTS AND INFORMATION
CONIAINED IN '1111E FOREGOING BID FOR PRBLI.0 WORKS ARE TRUE AND CORRECT.
Dated at South Bend this 1. 01 day of
y,f_LLY
........ . . ....... -
IowATF
_J J
By:
A�
J
_,1_ustin Hil
le "*** .... **... - , (Title of Person Signing)
ACKNVALEDGEMENT
STATE OF Indiana
ss
COUNTY OF
— -------------St.Jos . . . ........ .... eph .............................. . . . . ............
(Name of Organization)
VP of South Bend Area
Before me, a Notary Public, personally appeared the above -named. Dustin Hilary and
swore that the statements contained in the foregoing document are true and correct.
Subscribed and sworn to before me this ............................. I 4.'.h ........................................ .................................. day of Aprit 2020.
X11sha Krueger, Notary Pubji,
My Commission Expires: June 5. 2022
ALI HA KRUEGE I'l
S
R lPublic, sla�e of indiana
County of Residence: otery
owh
V-1. AL.
st, Joseph couOW
CornMission Expires
Julle ()6, 2022
Form 96 Section II, #2
Subcontractors Used on Public Works Contracts Du
SUBCONTRACTORS
the Past 5 Years
COMPANY ADDRESS CITY/STATE/ZIP PHONE FAX
SEWER
B & D Sewer
Deboer Egolf
Delta III
Dyer Construction
Gatlin Plumbing & Heating
Gough, Inc.
Grimmer Construction
Hasse Construction
HRP Construction
Rex Construction
Wirtz & Yates, Inc.
Woodruff & Sons
MILLING
C.E. Hughes Milling, Inc.
Javelina Construction, Inc.
Mid America Milling Co.
McCrite Milling
Specialties Company
ELECTRICAL INSTALLATION
Hawk Enterprises
Midwestern Electric
S/T Bancroft Electric
Sweney Electric Company
Trans Tech Electric
SIGN INSTALLATION
Hawk Enterprises
Midwestern Electric
RoadSafe Traffic Systems
State Barricading, Inc.
Traffic Control Specialists, Inc.
PAVEMENT MARKINGS
The Airmarking Company
Blackout Sealcoating
RoadSafe Traffic Systems
State Barricading, Inc.
Traffic Control Specialists, Inc.
Traffic Management Company
TRAFFIC CONTROLmmmITIT
RoadSafe Traffic Systems
Traffic Control Specialists, Inc.
Traffic Manaqement Company
LANDSCAPE
Great American Landscape
Hubinger Landscape
Slusser's Green Thumb, Inc.
T & J Landscape Service
531 Winston Ct
5772 Melton Road
2063 W 1250 S
1716 Sheffield Avenue
1111 E. Main Street
2200 E. 88th Drive
2619 Main Street
10 Lincoln Avenue
5777 Cleveland Rd.
700 Schiller Avenue
P.O. Box 41
P.O. Box 450
Schererville, IN 46375
Portage, IN 46368
Hanna, IN 46340
Dyer, IN 46311
Griffith, IN 46319
Merrillville, IN 46410
Highland, IN 46322
Calumet City, IL 60409
South Bend, IN 46624
Schererville, IN 46375
Kentland, IN 47951
Michigan City, IN 46361
(219) 322-2300
(219) 763-9700
(219) 797-4004
(219) 865-2961
(219) 924-6972
(219) 756-2200
(219) 924-1623
(219 )932-1611
(574)271-7800
(219) 322-8090
(219) 474-6542
(219) 872-8605
(219) 865-0065
(219) 763-9703
(219) 797-3008
(219) 865-2963
(219) 924-1401
(219) 756-2202
(219) 924-0328
(219) 932-6829
(574)271-0524
(219) 322-0031
19) 8795339
3113 Holmans Lane
Jeffersonville, IN 47130
(812) 725-8665
(812) 725-8672
13476 Britton Park Rd.
Fishers, IN 46038
(317) 841-8364
(317) 841-0075
6200 W. Hwy 62, Ste 400 Jeffersonville, IN 47130
(812) 282-2751
(812) 283-9846
209 Quality Ave. Ste 9
New Albany, IN 47150
(812) 941-0252
(812) 941-0852
9350 E. 30th St.
Indianapolis, IN 46229
(317) 594-0291
(317) 594-0271
1850 E. North St
Crown Point, IN 46307
(219) 662-8090
(219) 662-8093
1620 E. Chicago Ave
East Chicago, IN 46312
(219) 397-4444
(219) 397-8888
25020 State Road 2
South Bend, IN 46619
(574) 287-6490
9111 Louisiana St.
Merrillville, IN 46410
(219) 769-6007
(219) 769-0565
4601 Cleveland Road
South Bend, IN 46619
(574) 272-9673
(574) 271-0144
1850 E. North St
1620 E. Chicago Ave
3122 Olympia Dr
24963 U.S. Highway 20
1810 W Pacific Avenue
P.O. Box 526
7440 W. 87th Place
3122 Olympia Dr
24963 U.S. Highway 20
1810 W Pacific Avenue
3542 Highwav Avenue
3122 Olympia Dr
1810 W Pacific Avenue
3542 Highway Avenue
P.O. Box 235
210 E. 113th Avenue
125 Montgomery Street
8253 Wicker Avenue
Crown Point, IN 46307
East Chicago, IN 46312
Lafayette, IN 47909
South Bend, IN 46628
Knox. IN 46534
Rochester, IN 46975
Bridgview, IL 60455
Lafayette, IN 47909
South Bend, IN 46628
Knox, IN 46534
Highland, IN 46322
Lafayette, IN 47909
Knox, IN 46534
Hiahland. IN 46322
Dyer, IN 46311
Crown Point, IN 46307
Logansport, IN 46947
St. John, IN 46373
(219) 662-8090
(219) 397-4444
(317) 780-1825
(574) 287-2078
(574)772-7001
(219) 662-8093
(219) 397-8888
74)772-7002
(574) 223-5817 (574) 223-7959
(219) 864-2300 (708) 430-6910
(317) 780-1825
(574) 287-2078
(574) 772-7001 (574) 772-7002
(291) 746-2433
(317) 780-1825
(574)772-7001 (574)772-7002
(219) 746-2433
(219) 322-7033 (219) 322-4419
(219) 662-9911 (219) 662-6206
(574) 722-3102 (574) 722-1628
(219) 374-9900 (219) 374-9950
V ARDRAIL/I::"ENCING
Acorn Fence
C ..I'ech Corporation
James H. Dreg Company
Security Industries
Specialties Company
IT TRUCKIR6ALIN
C. Lee Construction Services
Condon Trucking, LLC
I:: anio Services
GilmerTrucking
MaterialTransfer Inc.
Morris Motor Service„ Inc.
P & C Trucking
Superior Construction Co., Inc.
V R 'trucking, Inc.
..........................�................................ ..
DAM"
K & S Markers, Inc.
UNDERSEAL
Rie'th-Dailey Construction Co.,
I no.
TREE REMO�WE—
Dave's Tree Service .. _............._
Horner Tree Service
Timber Masters LLC
- -LIMA: STABILIZATION
Mt. Carmel Sand & Gravel
Rock Solid Stabilization
Specialties Company
FIFE LINING
Indiana Reline, Inc.
SAW CUTTlNG
Diamond Coring C0., Inc..........
............................_.. _........_---
_...
ualky Saw Seal, Inc.
-mSEAL COATI N / 'TRIPING
irte Services, Inc.
Blackout ealcoating
_.. _ .._..�....�.._ _ ... ._..
DIVD RDRAIN
3D Company Inc.
2041 164th Street
5300 W. 10 Forth
6701 Zionsville Rd.
1000 Ceorgiana St.
9350 E. 30th 5t.
Hammond, IN 4 320
oggston„ 146110
Indianapolis, IN 46266
Hobart, IN 46342
IndianaDolis, IN 46229
Cary, IN 46406
Portage, IN 46366
South Bend, IN 46626
2169 N 600 W Thornto n, IN 46071
2454 West CR 450 North LaPorte, IN 46350
1555 Dark Vest Circle
14000 S. Archer Ave
P.O. Box 245
312 D. Main Street
10117 Kennedy Ave
7440 W. 67'th Place
3200 East CR 350 North
Munster, IN 46321
Lockport, IL 60441
Dyer, IN 46311
Mt. Carmel, IL 62663
Ringwood, IL 60072
Indianapolis, 146229
Sulphur Springs, IN
47366
Chicago, IL 60617
rid6eview.........._._.4._W.....����........wwwwwwww.
IL 60455
Highland, IN 46322
ridaview, IL 60455
Muncie, IN 47303
(219) 644-6441
(317) 63-2761
(317) 676-3629
(219) 942-9446
(317) 54-0271
PfIaffo:i►a' m
i
(765) 766-5040 (765) 533-5631
(219) 924-944
(219) 664-2300 (706) 430-6910
(765) 236-3326 ('765) 266-3344
7
General Form No. 96..rca.
Prosedbed, by the State Boaxd of
Accaanaen4s of Indiana, Revsed 1949.
Standard Questionnaires and
Financial Statement for Bidders
Prescribed by
THE STATE BOARD OF ACCOUNTS OF INDIANA
For use in investigating and determining the qualifications of bidders on public
construction when the aggregate cost of any such work, or improvement will be Five "17housand
Dollars or more.
These statements to be submitted under oath by each bidder with and as a part of his bid, as provided
by Chapter 306, page 1248, Acts of 1947
Submitted to , Cimof,wSouth Bend.,.Indiana
By................................ ---......... ..........._............Walsh.&_Keller, Inc.
Address 2,4358 SR 21,,,South,Bendw IN 46614
Date submitted
Filed
A.E. BOYCE CO., MUNCIE, IND.
IA Corporation
1
Sec. 2 ofan Act entitled "AN AC"I'concerning the awarding of contracts for the performance of ptiblic work and authorizing
the board of accounts to prescribe certain forms to be used in ascertaining dw responsibility of contractors who submit bids for the
performance of such work, providing for plans and speci.fication,,.s, providing for bids repealing certain laws and declaring an
einergenc,Y 7 (.Approved March 13, 1947.)
See., 2. Wlienever the aggregate costs of any work or improvement will be five thousand dollars ($5,000.00) or more, for the
purpose of enabling such board, cornriiission, trustee, officer or agent to ascertain arid determine which of the bidders submitting
bids Farr the performance of any such public work. is, in the judgment of such board, commission, trustee, officer or agent, the lowest
andJor best bidderand to exercise intelligently the discretion hereby conferred on such board, corrunission, tnjstee, orficer or agent:
each bidder shall. be required to subirdt under oath with and as a part ofhis bid a staternent of his experience, his proposed plan for
performing such work and the equidpirient which he, has availaffle for the performance of such work and a financial staternent. The
statements hereby required shall be submitted on forryis which shall be prescribed by the state board ofaccounts. The forms so
prescribed shall be designated, respectively, as the experience questionnaire, the plan and equipment, questionnaire and the
contractor's financial statement, and shall be based, so far as appficable, on the standard questionnaires and financial statement Farr
or
bidders as approved and recommended by the joint conference on construction practices, for use in investigating the qualifications
of bidders on public construction work, and the forins, so prescribed are hereby prescrilbed as the forms which shaU hereafter be
used by all such bow-ds, commissions, trustees, officers and agents in obtaining the information which N required in the
administration of this act. If the infon-nation submitted by any bidder on the forms herein prescribed is found, on examination, to
be unsatisfactory, the bid submitted by such bidder shall not be considered. (Burns Statutes 1933, Sec. 53-109) See. 2, Cbapter306,
Acts of 1947,
2
Y 1161191 ai Wimp 1 A14M
The following forms of questionnaires and financial statement are prescribed by the State Board of
Accounts in conformity with the statute set out on the preceding page.
These forms, properly filled out and attested, must accompany each bid of five thousand dollars or
more on any public work.
The forms are designed to cover all contracts for all kinds of work and the bidder is required to answer
such questions as are pertinent to the work upon which he is bidding. The purpose of the questionnaire and
financial statement, as set forth in the law, is to enable the awarding body to determine the qualifications
of the bidder to carry out successfully the contract if the same is awarded to him.
The bidder will find it to his advantage to answer fully all questions coming within the range of the
work upon which he is bidding. Particular attention should be given the "Financial Statement" and the
details relative to the assets and liabilities set out. This form is made in extensive detail so that the bidder
may explain his assets and liabilities in proper sequence and in a uniform manner.
T. M. HINDMAN,
State Examiner
Submitted by ............................ Walsh_& Kelly " Inc. ---- — -.--...........------- ....... { x A Corporation
p 1700 East Main Street,_Griffit„ 6319-1
Principal Office at _ __...... ., IN 4
To,...... City of South Bend, .Indiana _
EXPERIENCE QUESTIONNAIRE
The signatory of this questionnaire guarantees the truth and accuracy of all statements and of all answers
to interrogatories hereinafter made.
4. Have you ever failed to complete any work awarded to you?, _._No.....___If so, where and why?
Has any officer or partner of your organization ever been an officer or partner of some other
organization that failed to complete a construction contract? No .,If so, state name of individual,
other organization and reason therefore„ ........ _._
6. Has any officer or partner of your organization ever failed to complete a construction contract handled
in his own name? No ... If so, state name of individual, name of owner and reason therefor
7. In what other lines of business are you financially interested?
For what coq)oration or individuals have you perfon-ned work-, and to whom do you refer? —
BP
Tonn & Blank Constrixtion 1623 Greenwood Ave. 46360
. ......................................................... . . . . . . . . . . . ........................... . . . .... . . . ........... .,Mi hi an,C ty-IN
1 111-111K,-_6 -, - -A ..................
-- uiC. nc. 261M---tGrinim-eCnstrcto--am_ l-ligI&q0N322
I I ................ . . . . . . . . . .
[Jnivef slil��,,,o�fN,ot,r,eD..ame,5gl&_
Gough. Inc., 1151 SummI.CrownPoint-IN 46307
. .. ...................... . . . . . ..E. ........ . . . .......... . . . . ........... . . ..................................... . . ................ . . .................... . .................... . . . . . .......... . . - - - ----- --------------- . . . . ..... . ............................. . . .
9. For wgnat cities have you performed work and to wbom do you refer?
Town of Gflffith
-1-111-1.111- . . . . . . . . . ........................................................... . . ............................................... . . . .
................ . . . . . . . - Director of Public Works
Griffith IN
Tolwll of Schererville — - --------
I J_ I own.-Manao . ........ . ...... - —
Schererville.1'N
--------- - -- - I-P .................... .
City of Hammond
. . ........... ..... ........ . . . ____
j,1I-a1m1qiQn0L]N
Ciry of South.Bend
-.Jo
Cil. Enj;jnr I ee
........ - — — ------
South Bend., IN
Fo�rn o'f' S t'.' h- n
---I'll, . .......... . . . ..... - ------- - -----------
T ovai. ---------------------
St.John..[N
---- ----- ---- - ---
10. For what counties have you perforun ed work and to whom do you refer?
Lake County ........... . . . ...... . .
11 ...... . . .....................
Hi, Iwav-SI -rime
. . ......................... . . . . . . j- -_,- - _41� --- _-q- -_-- __
Crown Point, IN
-_ , _ ..... __ .... . . . . ..... . ................. -----
Porter
St-losp ph County
11 , Sq )erintendent
............ . .... . . ........................................................................................................................................
South Bend.I.N1 ...............
Ellairt Can Y... ........................ -----------------
jfj,a y. S wrintendent
u-�—
Elkhart, IN ------- --------- - - - - - --------- -
LaPorte County - - - - ---------- ------
Supqryu� ----------------------
Lapofle� IN
- - ..... . . .................
11. For what State bureau% or departments have you performed work and to whom do you
111ndJ4n,a,,N)artrn eP t of Tran-spoftion LaParte District LaPorte I.N
Qppartrnent of Natural Resources 1xidian
. ................. W . . ........ . . .....
12. Have you ever performed any work. for the U.S. Government Y'lells��'ll. .....��������l", ....... ... ................................... . . . . . . . . . . ......... .........
If so, when and to whom do you ref-br? ... . ....... . ........... . — - - ------
I.I.S.Arn C rps IV 0 4 of)Enu Ilmers ....... . . ....................... . . . ..... Chicago, IL
Indiana ional Guard. D f n In noun ,-FN _pjjt.,g_Admjnistratio
... ........... . . .................
Federal 19u �-Adminjstration Sterling YA ...... .......................................... . ....
13., What is the construdion.
ex erience of them
L)
individ
al ofyou
m organization? - --------- ------
INDIVIDUAL'S NAME
PRESENT POS.FHON OR
YEARS OF
MAGNITUDE AND
INWHATCAPACiTY
OFFICE
CONSTUCTION
TYPE OF WORJK.
- -----------------------
EM"ER-UNCE
........ . ...... ......
.Kevin.J. Kelly
President
33
A.H_Tvpes� . ......... . ...
General
lnm
_JeIf I ,,".Swan
E.xe. c.-u....-tie ..... V i c e res ident
.....P....
34
A I I T). eTs
.
.................................
SupAEnj" neerm
David J. Misirly
Vice President
33
Biturninous
Engineer
- — ---------- - -------I -------------- -
P ,
......... . . . . ...............
Greg A.11offman
Vice President
31
Biturn inous
Engineer
Pavia.1 - --------- - -----
John C. Wall
Vice President
41
All i2q,
Eq�pnecr
John M.. Jensen
Vice President
33
All t�j�e
General.Man4�pr
J.Michael
Secretary/Treasurer
.
46
......................
Administration
General Manager
Schaum.
Jamie I.... Tancos
---- - --------------- --
Controller
---- - - ---------------- - ................................ ............................... . .... ..
. 14
Administration
General Manag
per
South Bend, Qps.Mur
23
All i pes
En a incer
.... ..... . ....... . ....
Dustin.p. 1-fil"nj
.................................. . . ............................... .
. . ... . ......... . . . .... ..... .........
South Bend Area JWff
.........................................................................................
. .......... . . .......................... .
18
.................................
All � v
yL es
Mark E..
Engineer
28
All types
Engm.eer
Krachenfels
Keith A., G din
Enoineer
.
. ................ . LyPe § ......... . ...................... .
. . . . . . . . .................
...... Engine er
Nikolas G. Relias
. ................ . .....................
jneer
16
. . . ............................... ...
Bituminous
. . ................... ..... . . . . .............. .... .
En -me Ir
�eeeeeeeeeeeeeeee.a. - -- - --
Pavm��
PLAN AND EQUIPMENT QUESTIONNAIRE
The signatory of this questionnaire guarantees the truth and accuracy of all statements and of all answers
to interrogatories hereinafter made.
1. In what manner have you inspected this proposed work? Explain in detail.
Plans, Sj1ecifications. and Site Ins,��)ections
2. Explain your plan or layout for performing the proposed work
As directed by owner/engineer
3. The work, if awarded to you, will have the personal supervision of whom?
Kevin J. Kell° � Jeffrey L. Swan, David „J„Mis rly., Grego' � A Hoffman,_ Dustin_P. HiLt ��,_and„Lynn,J,
4. *Do you intend to do the hauling on the proposed work with your own forces?,Yes WW,
If so, give amount and type of equipment to be used As .needed
5. *If you intend to sublet the hauling or perform it through an agent, state amount of sub -contract or
agent's contract, and if known, the name and address of sub -contractor or agent, amount and type of
his equipment and financial responsibility,,,
Items 4,5,6 and 7 may not be applicable in all building contracts; if not, omit.
6
6. *Do you intend to do the grading on the proposed work with your own forces?
If so, give type of equipment to be used
7. *If you intend to sublet the grading or perform it through an agent, state amount of sub -contract or
agent's contract, and, if known, the name and address of sub -contractor or agent, amount and type of
hisequipment and financial responsibility.................................................................................................................................................................................................................. --- —-----------
8. Do you intend to sublet any other portions of the work? __._If so, state
amount of sub -contract, and, if known, the name and address of the sub -contractor, amount, and type
of this equipment and financial responsibility ..
9. From which sub -contractors or agents do you expect to require a bond? None
10. What equipment do you own that is available for the proposed work?
QUANTITY
ITEM
DESCRIPTION,
CONDITION
YEARS
PRESENT LOCATION
SIZE, CAPACITY,
OF
ETC.
SERVICE
5
Asphalt Plants
Various
Good
Griffith, South Bend,
Vallwaiso, Lowell, LaPorte
19
As .halt Pavers
Various
Good
Griffith, South Bend
4
Slipform Conc. Paver
Various
Good
Griffith, South Bend
3
Road Widener
Various
Good
... ........
Griffith, Sou
5
Motor Graders
CAT/J.D.
Good
. -- -
Griffith South Bend
5_4
Rollers
Various
Good
Griffith, South Bend
30
Rubber Tire Loaders
Various
Good
Griffith, South Bend
_15
Excavators -----._...
Various
Good
Griffith, South Bend
9
Bulldozers
Various
®.
�......
Good
...
_
Griffith, South Bend
...._. .......... .
6
LowBoy Tractors
Various
Good .._.. .-
- _____....
Griffith, South Bend
.
8
.... .........
Flatbed Dumd:s
.._.
Various
Good
_._
Griffith, South Bend
48
— - —
'h and 3/4 ton Pickups
_ .. _.. ..............
Various
..............
Good
......
., .....
— —
.... .") ...
Griffith South Bend
_..........._.....................
65
1 Ton Crew Trucks
...................... _. ..
Various
Good
Griffith, South Bend
3
Cold Planers
Wirtgen 1900
—
Good
...................... ......._.
Griffith, South Bend
DC
3
TrI Axle Dumb
Mack
Good
South Bend
12. How and when will you pay for the equipment to be purchased?
13. Do you propose to rent any equipment for this work?No If so, state type, quantity and reasons for
14. Have you made contracts or received firm offers for all materials within prices used in preparing your
proposal?
Do not give names of dealers or manufacturers,,,,,
Dated at ........_ South, Bendthis 1,4t'',,,,,, day of April" 2020
_Walsh & #dell Inc.,
(Name of,OrgpizatioI
° B
E a y.„ _
�=�stin Hilaa�y,,_VP_of S,
` � �° "itle of Person Signing)
STATE OF Indiana_..___
Iss.
COUNTY OF St,...Joseph
Dustin Hilaf __ being duly sworn deposes and says that he is VP of South Bend, Area of the
above , Walsh & Ke11 x I..nc.
(Name of Organization)
and that the answers to the questions in the foregoing questionnaires and all statements therein contained
are true and correct.
Subscribed and sworn to before me this e 14,`,------- day of APfil, 2020.
Alisha Krklet Notary Public
M Commission expires June 5� 2022
Y p AL
KRUEC R
SSF
PubtiC, Stilt® Ct tnJ+and
Nataod
8 �. c =e
St. Josopr county
. SEA � �
y Cornmiss:an c/p'irels
lJ 1iYviMv,1
WJ'U�.'4�xiuif'Xr
N
Ij ne x
CERTIFICATE OF EXISTENCE
To Whom These Presents Come, Greeting:
I, CONNIE LAWSON, Secretary of State of Indiana, do hereby certify that I am, by virtue of the laws of
the State of Indiana, the custodian of the corporate records and the proper official to execute this
certificate.
duly filed the requisite documents to commence business activities under the laws of the State of
Indiana on March 29, 1966, and was in existence or authorized to transact business in the State of
Indiana on March 16, 2020.
further certify this Domestic For -Profit Corporation has filed its most recent report required by
Indiana law with the Secretary of State, or is not yet required to file such report, and that no notice of
withdrawal, dissolution, or expiration has been filed or taken place. All fees, taxes, interest, and
penalties owed to Indiana by the domestic or foreign entity and collected by the Secretary of State
have been paid.
In Witness Whereof, I have caused to be affixed my
signature and the seal of the State of Indiana, at the City
of Indianapolis, March 16, 2020
0DNNIE I... WSt.`N
SEtimi31°."iARY OF STATE
AH certificates should be vpflidated Mere~ I�t3l;°a of/1�;���.��y� ir�,�;ewv/ ds8ur4����hrr�tsis�ate
Expires on ,prH 1.5, 2020.
CERTIFICATE OF QUALIFICATION
to provide
CONSTRUCTION SERVICES
for
PUBLIC WORKS PROJECTS
to the
STATE OF INDIANA
This Certification Board, having duly considered application for qualification in terms of apparent experience and financial
resources; and under the applicable Indiana Code 4-13.6-4 and adopted rules of this Board, hereby issues a
Certificate of Qualification to provide construction services to the State of Indiana for Public Works Projects to:
II
WALSH & KELLY INC I
1700 I : MAllN s"r
GR1111: lC" I'T"P IIN 4631
Phone 219w 24-5900
I" ax. 219-924,,8768
Company OfficW
ICI; VIIIP1 II II!!!;;l,,.11-y
fair the tvaPeoalyseven month peflod stated her n, unless invoked b'I" Hiis Board for cause,
and inthe clas,sifloatiorus of services states] below. This rertificate superaedes any previous cerfiflcate.
1611.01 Coincrote Comtstrtuctiio n of I"loads 8 Curbft
1611X2 AsplhaUt Constirtictiiomn of Roads and Ifwarlkling I,,.ots
CERTIFICATION DATE 3/1412018
EXPIRATION DATE 6N4/2020
THIS CERTIFICATE ISSUED BY THE STATE OF INDIANA, PUBLIC WORKS DIVISION CERTIFICATION BOARD,
402 WEST WASHINGTON STREET, ROOM W467, INDiANAPOLIS, INDIANA 46204,
ALSO ACTS AS THE OFFICIAL NOTICE OF EXPIRATION.
Tracy L. Cross, Executive Sf>etretary
Certification Board
DAPW PQ2 State Form 3983R Rev. 07106
WRITTEN CONSENT TO RESOLUTIONS
of the
BOARD OF DIRECTORS
of
WALSH & KELLY, INC.
The undersigned, being all of the Directors of WALSH & KELLY, INC., an Indiana Corporation,
hereby consent to the following actions to be taken by the Corporation without a meeting of the Board of
Directors under the applicable provisions of the Indiana Business Corporation Law, as amended:
RESOLVED that the following be, and hereby are, elected officers of the Corporation, to
hold the office until the next regular meeting of the Board of Directors and until their
successors are duly elected and have qualified:
John M. Peisker, President
Jeffrey L. Swan, Executive Vice President
John P. Vercruysse, Executive Vice President
Jamie L. Tancos, Vice President of Finance, Secretary & Treasurer
Gregory A. Kelly, Vice President
Charles Potts Jr., Vice President
Albert E.VanDenBergh, Vice President
David L. Franz, Vice President
David J. Misirly, Vice President
Gregory A. Hoffman, Vice President
Dustin P. Hilary, Vice President
Lynn J. Bauer, Vice President
Mark E. Krachenfels, Vice President
RESOLVED FURTHER that the actions of the Officers of the Corporation taken since the
last meeting of the Board of Directors be, and the same hereby are, fully ratified and
approved.
RESOLVED FURTHER that the following be, and they hereby are, authorized to execute
all contracts or similar documents on behalf of the Corporation:
John M. Peisker, President
Jeffrey L. Swan, Executive Vice President
John P. Vercruysse, Executive Vice President
Jamie L. Tancos, Vice President of Finance, Secretary & Treasurer
Gregory A. Kelly, Vice President
Charles Potts Jr., Vice President
Albert E.VanDenBergh, Vice President
David L. Franz, Vice President
David J. Misirly, Vice President
Gregory A. Hoffman, Vice President
Dustin P. Hilary, Vice President
Lynn J. Bauer, Vice President
Mark E. Krachenfels, Vice President
RESOLVED FURTHER that this consent shall be in lieu of an annual meeting of the Board
of Directors of the Corporation and shall be filed in the minute book of the Corporation in
place of any such annual minutes.
<<SIGNATURES ON THE NEXT PAGE>>
EXECUTED this 15"' day of January, 2020.
Fred
Albert E. VanDenBergh
Kevin J. Kelly
... .... ..... . . . .... ... ...
. J .. a .. m .. e .. s . �9re I I I d
A
ysse
EXECUTED this 15'h day of January, 2020.
Fred Fehsenfeld, Jr. James C. Fehsenfeld
c2"
IN
Albert E. VanDenBergh John P. Vercruysse
Kevin J. Kelly
EXECUTED this 15'' day of January, 2020.
Fred Fehsenfeld, Jr.
James C. Fehsenfeld
Albert E. VanDenBergh John P. Vercnrysse
Kevin J Kell"
Y`
oz ATF
r
t „ u�u� jana m ,r u s a �slm Ellie t' South Sm
Walsh &wiof f Illlf
M M�nu�n II �n�M° @ ������
Phio 219) 900 M cin 7 MMnM'M� M M
Equal Employment Opportunity/AffirmativeAction lipStatement
It is the policy of Walsh & Kelly to afford equal opportunity for employment to all indilviduals regardless
of race, color, religion, sex, sexual orientation, gender identity, national origin, age,'disability, housing
status, or veterans' status. The corporation is committed to this policy by our status as a federallly
assisted government contractor. We are fair more stroirnly bound to -the policy by the fact that
adherence- to the principles involved is the only acceptable American way of life.
Therefore, it is the policy of this corporation to assure that applicants are employed, and that employees
are: treated during employment without regard to race, color, religion, sear, sexual orientation, gender
identity, national origin, age, disability, housing status, or veterans` status, .Such action shall indlude:
employment, upgrading, dennotion, or transfer; recruuitinment or recruitment advertising; layoff or
termination; rues of pay or other forirns of compensation; and selection for traWin , including
apprenticeship, pare -apprenticeship, and/or on -the -gob training,
The successful achievement of a nondiscriminatory employment program requires a maximum of
cooperation between management and employees. In fulfilling its' part in this cooperative effort,
management is obliged to (lead the way by establishing and implementing affirmative procedures and
practices which will ensure our obJective, namely equitable employment opportunity for all. (Mlinority
and fernMe employees are encouraged to participate in all company activities and refer applicants„)
Our company will talke affirmative action to ensure that we will
(1) recruit, hire and promote all job class iifications without regard to race, color, religion, sex,
sexual orientation, gender identity, national origin, age, ancestry, disability, veterains status or housing
status;
G D base decisions on employment so as to further the (principle of equal employment
opportunity;
() ensure that promotion decisions are in accord with principles of equal emmployment
opportunity by imposing only valid requirements for proinnotional opportunities;
() ensure that all personnel actions such as compensation, benefits, transfers, layoffs, return
from layoffs, company sponsored training, education, tuition assistance, social and recreation programs
will be administered without regard -to race, Collor, religion, seer, sexual orientation, gender identify,
national origin, age, disability veterans status or housing status.
I have designated Amy Wright, VP, HR and "ralent Development, as the Equal Opportunity Officer to
direct the establishment of and to rnonitoir the Implementation of personnel procedures to wide our
affirmative action program, This official is charged with designing and implementing audit and reporting
systems that will (keep mainagement Informed on a regular basis of the status of equal employment
opportunity and affirmative action. She can be reached at Q, t b6 6- 9 y.
Employees will be made (mown of our commitment to equal employment through -the following means:
0 hosting of equal opportunity notice on bulletin boards
EOE WF/Vets/Disabled
GRIFFITH
END
Walsh
" wtw t�o� F I I �
i
mtlp�ml� �����Gs�� N �� 19 INWWWRIShkellycowl South Bend, III Aana,46614
60)v n. tax 019' 924, 8768 Fax 0714) 289..71 uM
Including our equal opportunity statement in our Handbook which is disseminated to all
employees
Annual supervisory training
Potential employees will be made aware of our policy through the following means:
• By including the words "Equal Opportunity Employer" or EOE in all advertisements and notices
for job openings
Sending notices to union affiliations
Posting of equal opportunity notice on all company and job site bulletin boards
Except when precluded by valid bargaining agreements, we will conduct systematic and direct recruitment
through public and private referral sources likely to yield qualified female and minority group applicants.
This recruitment will be conducted by direct and personal contacts with female and minority organizations
in the project area.
All union organizations with which we come into contact, including Laborers, Carpenters Operators, and
Teamsters, will be made aware of, and provided copies of our plan. They will be informed of our desire
for them to implement our program and will be specifically asked to refer females and minority group
employees for employment.
It is our policy that wages, working conditions and employee benefits will be determined and administered
on a non-discriminatory basis. We will conduct periodic reviews of wage rates, employee benefits, and
promotional capabilities to assure they are administered in a non-discriminatory manner.
Supervision has been made to understand that their work performance is being evaluated based on
their equal employment opportunity efforts and results, as well as other criteria. it shall be a
responsibility of the supervision to take actions to prevent harassment of employees placed through
affirmative action efforts.
We shall comply with the Civic Rights Act of 1964, as amended, the Federal Highway Act of 1968, the
Executive Order #11246 and #11375, the Rehabilitation Act of 1973, as amended, the Vietnam Era
Veterans Readjustment Assistance Act of 1974, as amended, the Indiana Civil Rights Act and other
applicable Federal and State Laws and regulations pertaining to equality of Opportunities and
Affirmative Action policies. We have developed an Affirmative Action Program for Veterans and
Individuals with Disabilities.
Ihn Peisker, President, Walsh &
Date..,.
ME WF/Vets/Disabled
(HUFFIT114 SOUTI-1 BEND
Walsh & V11100 111IsMagn Street 24358!SR 23
WMN."Walslikelly.cum Swah Rend, indiarm 466t,14
gllhone f219)!:024-5900 Phone (57Q �!S& 18 11
Kellyll.c. 11F�ax Fax (571101 2,99-7174
DME: April 13, 2020
Ta. All Employees
RE: EEO Officer Appointment
Amy Wright, VP, HR and Talent Development, has been appointed Equal Employment
Opportunity Officer for Walsh & Kelly. It is her responsibility -to coordinate, advise and assist
management and supervisors in their responsibilities of assuring all applicants and ernployees'
equal opportunities in all aspects of their employment., She will review complaints that allege
discrimination because of race, relligion, color, sex, sexual orientation, gender Identity, age,
national origin, disability, housing status or veteran status.
Employees of Walsh & Kelly are to submit any issues or concerns to Amy. We are committed to
comply with the provisions of the Civil Rights Act of 1.964 and 1991, plus all Executive Orders
issued relating to Equal Employment.
Arny's contact information is listed below,
Heritage Construction and IMaterials
R.O. lBox 421459
ffid4napofis, IN 46242
1 He S ton0p,,
(31-7)616 4907(o)
(317)474 2559 (m)
otiMptij
0&
.... .... .. .........
ioKrT'Oeisker, President
% 46 J.;b,
11111111101
i
i`
1. a •1 .. . a �. 1� J it � 1 J 1
INDIANAPOLIS, IN April25, 2019
TO
WALSH & KELLY INC GRIFFITH, IN
who has filed with the Department a Contractor's Statement of Experience and Financial Condition as
required under Indiana Code 8-23-10, is hereby qualified to bid at any Department of Transportation
letting in Classes of Work and within the amount and other limitation of each classification as listed
below, for such period as the uncompleted work on hand from all sources does not exceed the Aggregate
amount. Classification references by name or symbol are in accordance with the definitions in the
Contractor's Statement of Experience and Financial Condition. This certificate supersedes any certificate
previously issued, but is subject to revision or revocation according to the law, if and when changes
in the financial condition of the contracting firm or other facts justify such revision or revocation.
Valid May 1, 2019 Th ru April 30, 2020
AGGREGATE....................................................................................................................................... $UNLIMITED
A(B) CONCRETE PAVEMENT: LIMITED......................................................................................................... $25,000,000
B(A) ASPHALT PAVEMENT: WANDOT CERTIFIED HMA...........................................................................$UNLIMITED
C(B) LIGHT GRADING.......................................................................................................................................$UNLIMITED
E(E) SMALL STRUCTURES AND DRAINAGE ITEMS.................................................................................... $25.000,000
-(F) SURFACE MASONRY AND MISC CONCRETE...................................................................................... $50,000,000
E(G) TRAFFIC CONTROL: PAVEMENT MARKINGS...................................................................................... $25,000,000
E(H) DEEP SEWER AND/OR EXCAVATION.................................................................................................... $25,000,000
E(Q) CONCRETE PAVEMENT REPAIRS.......................................................................................................... $25,000,000
E(R) ASPHALT PAVEMENT NULLING..........................................................:................................................... $50,000,000
PREQUALIFICATION ENGINEER
State F0 20508 (R3 / 5-05)
"MISSIONLRWWW
1316 Ch uu,'n r'-Crr ,, R ICI DNf,.
227".JETFuRS0i1rV30�I1EIVAR,D
SaaL,TH tl7ENi::�, rvl°MDV,ril° A 4660'll..'1830
13( Ait@It OF MtLIC"WORKS
PIHONII: 5 74/23 y 9255ll
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM
Date Received: 4/6/20
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 attached documents are hereby added to the Specifications and Contract
Documents and become a part of herein.
Company:
Walsh & Kelp„`"In
Authorized Signature:
n Hilary, VP of South Bend Area
Date: 4/6/20
1316 Ch uu,'n r'-Crr ,, R ICI DNf,.
227".JETFuRS0i1rV30�I1EIVAR,D
SaaL,TH tl7ENi::�, rvl°MDV,ril° A 4660'll..'1830
13( Ait@It OF MtLIC"WORKS
PIHONII: 5 74/23 y 9255ll
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM
Date Received: 4/6/20
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 attached documents are hereby added to the Specifications and Contract
Documents and become a part of herein.
Company:
Walsh & Kelp„`"In
Authorized Signature:
n Hilary, VP of South Bend Area
Date: 4/6/20
DIVISION
B - PCC MATERIALS
Item No.
Description
Quantity
Unit
Unit Price
Total
B-1
Class A Concrete
2500
CY
No Bid
No Bid
B-2
Class A High Early
800
CY
No Bid
No Bid
B-3
7 Bag Mix - New City Specs
600
CY
No Bid
No Bid
B-4
High Early Concrete w/ Integral Color -
350
CY
No Bid
No Bid'
Black
B-5
Plowable Fill, Removable
350
CY
No Bid
No Bld
B-6
Non -Chloride Accelerator added to
325
EA CY
No Bid
No Bid
concrete — 0.5%
B-7
Non -Chloride Accelerator added to
1000
EA CY -.
mmmmmITITITITITITITITITITIT No Bid
No Bid
concrete — 1 %
B-8
Non -Chloride Accelerator added to
2100
EA CY
No Bid
No Bid
concrete — 2%
-. _ _... �................
DIVISION B TOTAL
No Bid
DIVISION
C - AGGREGA-rE MATERIALS
Item No.
Description
Quaintrity
Unit
Unit Price
Total
-- ----
No., 23 Sand
-5006
IFON
$
11.50$.-
57,500.00
C-2
. ...............
No. 53 Graven1000
TON
$
14.00
$.....__
.......... --
--]
14,000.00
C-3
No. 53 Recycled Concrete
7500
- ------- .
TON
. . ........................
$
11.00
$
82,500.00
C-4
. ......
No. 53 Slag
1000
TON
$
16.50
$
16,500.00
C-5
Topsoil
150
CY
$
25.00
$
3,750.00
C-6--
. . . . ................ .. .. .. . . . . .. .. .
No., 11 Slag Chiip Stone
1000
TON
$
21.00
$
21,000.00
. ....................
DIVISION C TOTAL
$
195,250.00
DIVISION
D - SEWER MATERIALS - CASTINGS
. .................................... ............... ................ ... . . ..........
. . .........
. . ...................
.
. . . . .......................
. . . . . . .
Item No.
Description
Quantity
Unit
Unit Price
Total
D-1
Manhole Cover and Frame: EJ
300
EA
No Bid
No Bid
1040A or Neenah R-1642 (Circle
One)
D-2
Catch Basin Cover & Frame: EJ
300
EA
No Bid'
No Bid
1020-M1 or Neenah R- 1642
(Circle One)
.
.........................
DIVISION D TOTAL
No Bid
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 - 7/8"L
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
w--
20
EA
No Bid
No Bid
.......
E-6
MH Riser 21 3/4" D - 1 1/2"R - 1
30
EA
No Bid
No Bid
3/8"L
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-10
MH Riser 22 1 /4" D - 1"R - 1 1/2"L _
30
EA
No Bid
No Bid
E-11
MH Riser 22 1/4" D - 1 1/2"R - 1
30
EA
No Bid
No Bld.
1/2"L
E-12
MH Riser 23" D -1 "R -1 3/4"L
30
EA
No Bid
--__..................
No Bid
E-13
_.............
MH Riser 23" D -1 1 /2"R - 1 3/4"L
20
EA
No Bid
No Bid
DIVISION
E -SEWER MATERIALS CONTINUED
Item No.
Description
Quantity
Unit
Unit Price
Total
`MH —Riser 23- D - 2"R - I 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
No Bid
1/8"L
E-16
MH Riser 23 5/8" D - 2"R - 1 1/8"L
10
EA
No Bid
No Bid
E-1 7
........... . . . . ......... . .......
MH Riser 23 5/8" D - 1 "R - 1 1/2"L
20
EA
No Bid
No Bid
E-18
MH Riser 23 5/8" D - 1 1/2"R - 1
25
EA
.
No Bid
. . . . ......................
No Bid
1/2"L
E-1 9
MH Riser 23 5/8" D - 2"R - I 1/2"L
20
EA
...... . ......................... .
No Bid
No Bid
E-20
MH Riser 23 5/W b i "R 1
..... .
EA
. . ..... . ......... . . . ..................... .. ........
No Bid
No Bid
1/2"L
71
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
..............
2_200 . .....GAL
No Bid
No Bid
Marking Paint - Yellow
F-3
Pavement Marking Beads,
466-0-0-
LBS
No Bid
No Bid
Standard
DIVISION F TOTAL
No Bid
DIVISION
G SNOW REMOVAL MATEIRIAll...,S
Train No
''' Description
Quantity
Unit
Unit PIrII
Dotal
G I
�. _ ........
Gury d IDoublle Bevel Carbon Sty l
360
A
No laud
-.......�
No Bird'
U nderbody If:illade 5"II... x 6"T x 5/8"Th
G-2
Curved Single Bevel Carbon Stull
50
If::A
No Biid
No Bid
U nderlbody Made 51... x 6"T x 3/4"TKO
Heat Treated — Hardened
G-3
Curved Siirngle Bovell Carbon Stool
50
EA
No Bid
No Bid i
Underlbody Made 61...x 6"T x 3/4,,"rh
Heat Treated ...... Hardened
4
.....�...................................w.w...w.............,.. .....r
Boss Po�ror �/ Blow- Bla.do 5t "" X
+.r. .......nrrmrry
6
....,,e,...... .
If:::A
...............,..�..�..�.....
No Bid
..www.d. _.._ ..............
No Bid
Flart # BAI...66658 Passenger Side Edge
G.5
Boss Po er V 1:11low Blade 51'
6
I.: A
No Bud
No Bid
Part # BAIl...96659 Drivers Side Edge
G-6
3" 6" Western VP Mu s Flour Blade
6
EA
No Bid
No Bid
D'art # 44285-1
G.4
Western Pro Plus Row Blades 90"L x
3 m
If.::A
mmIT No laid
No Bid
6"T x t /2"°Th
.
_........ .
DIVISION G TOTAL
No Bid
DIVISION
H - ASPHAt r MATERIALS
CONT'D
—Tlt—eim
Description
..................... . ..........................
Quantity,
. ..... --------
Unit
Unit Price
. ......
Total
No.
H-1
AE-T "rack
25,000
GAII
No Bid
No Bid
H.-.2
RS-2
..............
25,000
. ... ............ - I
-43A—L
No Bid
-- . ..... . . . .............. . . ...... —K-o —Bid:
.... ........... .................
. . . .
..
.................. . .
DIVISION H TOTAL
No Bid�
DIVISION
......................... . — . . . .............. . . . .............................
I - DELIVERY OF HMA MATERIALS BY TRI-AXLE TRUCK
..........
Item
Description
Quantity
Unit
—
Unit Price
— — - - — - - - ----------------------..___-
Total
No.
—Truck
1-1
Driver and
66-0—
PER HR— $12-5.00
—
$ 7 1 5,000.00
. . ................... . . . . --1-
. . . . ............................ .
..................
.
..................... . .
DIVISION I TOTAL
...... ............
$ 75,000.00
Bidder §,h & Inc.
City/State/� out d IN 614
wwwwwwwwwww
By
(Signature)
Dustin Hilary, VP of South Bend Area
(Printed Name of Person Signing)
Address: 24358 SR 23
Telephone Number: _L574 )_288-4811
I I i I I I jJ0 .4
y,ELL)- Iflo,
Ilk
C)RAT4, %
C H U B B" Surety O +908.903.3485
202B Halls Mill Road, PO Box 1650 F + 908.903.3656
Whitehouse Station, NJ 08889-1650
Federal Insurance Company
AIA Document A31OTM - 2010 Bid Bond
Anysingular reference to Contractor, Surety, Ovvner or other party shill he considered plural where applicable.
CONTRACTOR
(Name, legal status and address):
Walsh & Kelly, Inc.
24358 State Road 23
South Bend, IN 46614
OWNER
(Name, Iegal status and address):
City of South Bend, Indiana, Board of Public Works
227 W. Jefferson Boulevard
South Bend, IN 46601
BOND AMOUNT 5% Five Percent of the Total Bid
PROJECT
(Name, location or address, and project number, if any)
SURETY
(Name, legal status and principal place of business):
Federal Insurance Company
202B Halls Mill Rd., PO Box 1650
Whitehouse Station, iQ 08889-1650
2020 Street and Sewer Department Materials, Project No. 120-005
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, jointly and
severally, as provided herein. The conditions of this Bond are such that if the Owner accepts the bid of the Contractor
within the time specified in the bid documents, or within such time period as may be agreed to by the Owner and
Contractor, and the Contractor either (1) enters into a contract with the Owner in accordance with the terms of such
bid, and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a surety admitted
in the jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful 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 in said bid and such larger amount
for which the Owner may in good faith contract with another party to perform the work covered by said bid, then this
obligation shall be null and void, otherwise to remain in full force and effect. The Surety hereby waives any notice of
an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver
of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for
acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for
an extension beyond sixty (60) days.
If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall
be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor.
Printed in cooperation with the American Institute of Architects (ALA) by Chubb. The language in this document conforms to the language used in
AIA DocumentA310 m-2010.
Form 15-02-0575-FED (Rev. 3/17)
Whenthis Bondhasbeen furnishedto complywith a statutory or other legal requirement in thelocation ofthe Project,
any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted here
from and provisions conforming to such statutory or other legal requirement shall be deenied incorporated herein.
When so furnished, the intent is that this Bond shall be construed as a statutory bond and not as a common law
bond.
Signed and sealed this 14th
(Witness) Alisha Krueger, Administrative A 4-Istant
'A
- �ffl
(Witness) Anna C. Oliger, Administrative Assistant
day of April, 2020
Walsh & lKeYy',Aq,a
tin Hil Vice Pr ent:
(Title)
C-i .1 ®�
® VORATF
a
Aw
oww
Federal Insurance Company
(Attorney -in Fact) David lM.911"ger
zAN V
(QRO,rateSeal)�
Printed in cooperation with the American Institute of Architects (ALA) by Chubb. The language in this document conforms to the language used in
AM DocumentA310 7m-2010.
Form 15-02-0575-FED (Rev. 3/17)
f
,COMPANY, a Wisconsin corporation, WESTCHESTER FIRE INSIU NCE COMPANY and ACE AMERICAN INSURANCE COMPANY corporations of the Commonwealth of
Surety Bond Number: Bid Bond
bllgee: City of South Bend, Indiana, Board of Public Works
each as their true and lawful Attorney-m-Fact to execute under such designation In their names and to affix their corporate seals to and deliver for and on their behalf as surety
thereon or otherwise, bonds and undertakings and other writings obligatory in the nature thereof (other than ball bonds) given or executed in the course ofmisiness, and any
instruments amending or altering the same, and consents to the modification or alteration of any Instomment referred to in said bonds or obligations.
In Witness Whereof, said FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, PACIFIC INDEMNITY COMPANY, WESTCHESTER FIRE INSURANCE COMPANY
and ACE AMERICAN INSURANCE COKPANY have each executed and attested these presents and affixed their corporate seats on this lot day of No her, 2019.
Dawn M. Chloros, Assistant Secretary
STATE OF NEW JERSEY
County of flunterdon SS.
On this 1d day of November, 2019, before one, a Notary Public of New Jersey, personally came Dawn M. Chloros and Stephen M. Raney, to one known to be Assistant Secretary and
Vice President, respectively, of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, PACIFIC INDEMNITY COMPANY, WESTCHESTER FIRE INSURANCE COMPANY
and ACE AMERICAN INSURANCE COMPANY, the companies which executed the foregoing Power ofAttorney, and the said Dawn M. Chloros and Stephen M. Raney, being by me duly
sworn, severally and each for herself and himself did depose and say that they are Assistant Secretary and Vice President, respectively, of FEDERAL INSURANCE COMPANY,
VIGILANT INSURANCE COMPANY, PACIFIC INDEMNITY COMPANY, WESTCHESTER FIRE INSURANCE COMPANY and ACE AMERICAN INSURANCE COMPANY and know the
corporate seals thereof, that the seals affixed to the foregoing Power of Attorney are such corporate seals and were thereto affixed by authority of said Companies; and that their
signatures as such officers were duly affixed and subscribed by like authority.
ai
NOTARY PUBUO OF NEMIJERMY
Na 2316aw
r
COMPANY and ACE AMERICAN INSURANCE COMPANY (the'Conspardes') do hereby certify that
(I) the foregoing Resolutions adopted by the Board of Directors of the Companies are true, correct and in full force and effect,
(9) the foregoing Power of Attorney Is true, correct and In full force and effects
Given under my hand and seats of said Companies at Whitehouse Station, NJ, this April 14, 2020.
h)Pn�r
2.
w �' �"eP age n ) r° t Dawn M. Chloros, Assistant Secretary
._._... _.......... WW .....�„ .1`ed lh®ne99oeI903®�33 �ma�F , 9„O�p, 03 3656 � ,ma[I: Sur �Fl67`f6E,PL ......E CC IfSAT':
IN THE YOU WISH TO VERIFYTHE A ENTICITI �FTFI[S i3t1ND �ft Nt71 [FYUS ®F I{E IT
Coaobl : FED-VIG-ICI- iC iC ( . 11-19)
Part of State FormS2414 (R2 / 2-13) Form 96 (Revised 2013)
Walsh & Kell, Inc.
(Contractor)
(Address)
South Bend IN 46614
FOR
PUBLIC WORKS PROJECTS
OF
Cit of South Bend Indiana
2020 Street and Sewer De artment Materials
Project No, 120-005
Filed Aril 14th, 2020
Action taken
State Form 52414 (R / 9-10)
P[ejrmbqd day State Bgarrl_q r—SounlLi .. .. ______.. ..... _ Form N . 96 R is 0
CONTRACTOR'S BID FOR PUBLIC WORK — FORM 96
PART 1
(To be completed for all bids. Please type or print)
Date (month, day, year): Apri11W14,.2020
1. Governmental Unit (Owner): City of South Bend, Indiana
2. County: St. Joseph
3. Bidder (Firm):
Address:
City/State:
4. Telephone Number:
5. Agent of Bidder (If applicable):
Walsh-4-Kelly,-Inc . .
24358 SR2.3. ,,,...
South Bend, IN 46614„ww ee
(574') 288-4811
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the public
works project of City of South Bend, Indiana — Board of Public Works and Safety (Governmental Unit) in
accordance with plans and specifications prepared by Department of Public Works — Division of Engineering
and dated March 2020 for the sum of See Attached See Attached.
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. I hereby certify 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.
ACCEPTANCE
The above bid is accepted this day of _ subject to the following conditions:
Contracting Authority Members:
PART II
(For projects of $150,000 or more —IC 36-1-12-4)
Governmental Unit: City of South Bend, Indiana
Bidder (Firm): Walsh & Kelly, Inc.
Date(month, day, year)
These statements to be submitted under oath by each bidder with and as part of his bid. Attach additional pages
for each section as needed.
SECTION I EXPERIENCE QUESTIONNAIRE
Have you ever failed to complete any work awarded to you? No If so, where and why?
5. List references from private firms for which you have performed work.
Gatlin Plumbing,. & Heating, Inc. l I I I E. Main St..;.Griffith, IN Ms. Clara Murrl by,
.... .....
Gough Inc 2200_E. 88" Dr.. Merrillville, IN 464.1.0 Mr.....Ra Raymond Gough
................................... ............. -
Dyer Construction Co , _1716 Sheffield Avenue,.. Dver, IN --_Janet Furman _
Grimmer..Construction,,,Co , Inc. 2619.Main .Street, HI hland IN.mmMr. Grua Grammer ,,,
SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE
1. Explain your plan or layout for performing proposed work. (Examples could include a narrative of when you could
begin work, completed the project, number of workers, etc. and any other information which you believe would
enable the governmental unit consider your bid.)
As required by owner
2. 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.
See Attached List
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.
Will supply upon award of contract
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.
QUANTITY
ITEM
DESCRIPTION,
CONDITION YEARS
PRESENT LOCATION
SIZE, CAPACITY,
OF
...... m
ETC
SERVICE
Asphalt Plants
Various
Good
Griffith, South Bend,
— _
Valparaiso, Lowell LaPorte
_...Asphalt Pavers.......
Various �....... ........
Good
�m,,,,.,.,,,,,,,,.
Griffith, South Bend 1
----- - ----
...................................19
4
Slipform Conc. Paver
Various
Good
Griffith, South Bend
3
Road Widener
Various
Good
Grtfl7th South Bend I
5
......
Motor Graders
CAT/J.D. D
Good
Griffith, South Bend
54
Rollers
Various
Good
Griffith, South Bend
30
Rubber Tire Loaders
.. --
Various
Good
Griffith, South Bend
...........___...._
15
Excavators
Various
Good
Griffith, South B end
9
Bulldozers
zers
arlous
_ _..
ood.�
Griffith South Bend
Griffith, ..
6
LowBov Tractors
_ _ _
Various
Goo .
Griffith, South Bend
8
Flatbed Dumb s
Various ----
Good I ....
Griffith, South Bend
...... ..
48
..._
'/z and .
�.
...... .... .. .......... -
------- -- _.... ._..._.__
65
.
1 Ton Crew_ _ Trucks
Various
Good
Griffith, South Bend
..........................................................
3
Cold Planers
Wirtgen 1900
Good
od
Griffith, South Bend
DC
3
TrI Axle Dum
Mack
Good
South Bend
5. Have you entered
into contracts or received
offers for all materials
which substantiate
the prices used in preparing
your proposal?
Otherwise, please explain
the rationale used
which would corroborate
the prices listed.
Yes, we received
quotes from potential
subcontractors and suppliers
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.1hereunder to the governing body awarding
the contract must be specific enough in detail so that said governing body can make a proper deten-nination ofthe bidder's
capability for completing the project if awarded.
SECIIONIV CONTRACTOR'S NON CO.I....LUSIONAFF1.11 )ANT.1'
11le undersigned bidder or agent, being duly sworn on oath, says that lee has not, nor :has any other inernber,
representative, or agent of the firin, company, corporation or partnersliip 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 torefrain from bidding, and that this bid is made without reference to any other bid and
without any apreement, understanding or corn1bination with any other person in reference to such bidding.
Ile 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
s.EcriON V 0A.111. AND AFFIRMATION
I HEREBY AFFIRM UNDERTHE PENALTIES FOR PERAJKYTHATTFIE FACTS AND INFORMATION
CONIAINED IN '1111E FOREGOING BID FOR PRBLI.0 WORKS ARE TRUE AND CORRECT.
Dated at South Bend this 1. 01 day of
y,f_LLY
........ . . ....... -
IowATF
_J J
By:
A�
J
_,1_ustin Hil
le "*** .... **... - , (Title of Person Signing)
ACKNVALEDGEMENT
STATE OF Indiana
ss
COUNTY OF
— -------------St.Jos . . . ........ .... eph .............................. . . . . ............
(Name of Organization)
VP of South Bend Area
Before me, a Notary Public, personally appeared the above -named. Dustin Hilary and
swore that the statements contained in the foregoing document are true and correct.
Subscribed and sworn to before me this ............................. I 4.'.h ........................................ .................................. day of Aprit 2020.
X11sha Krueger, Notary Pubji,
My Commission Expires: June 5. 2022
ALI HA KRUEGE I'l
S
R lPublic, sla�e of indiana
County of Residence: otery
owh
V-1. AL.
st, Joseph couOW
CornMission Expires
Julle ()6, 2022
Form 96 Section II, #2
Subcontractors Used on Public Works Contracts Du
SUBCONTRACTORS
the Past 5 Years
COMPANY ADDRESS CITY/STATE/ZIP PHONE FAX
SEWER
B & D Sewer
Deboer Egolf
Delta III
Dyer Construction
Gatlin Plumbing & Heating
Gough, Inc.
Grimmer Construction
Hasse Construction
HRP Construction
Rex Construction
Wirtz & Yates, Inc.
Woodruff & Sons
MILLING
C.E. Hughes Milling, Inc.
Javelina Construction, Inc.
Mid America Milling Co.
McCrite Milling
Specialties Company
ELECTRICAL INSTALLATION
Hawk Enterprises
Midwestern Electric
S/T Bancroft Electric
Sweney Electric Company
Trans Tech Electric
SIGN INSTALLATION
Hawk Enterprises
Midwestern Electric
RoadSafe Traffic Systems
State Barricading, Inc.
Traffic Control Specialists, Inc.
PAVEMENT MARKINGS
The Airmarking Company
Blackout Sealcoating
RoadSafe Traffic Systems
State Barricading, Inc.
Traffic Control Specialists, Inc.
Traffic Management Company
TRAFFIC CONTROLmmmITIT
RoadSafe Traffic Systems
Traffic Control Specialists, Inc.
Traffic Manaqement Company
LANDSCAPE
Great American Landscape
Hubinger Landscape
Slusser's Green Thumb, Inc.
T & J Landscape Service
531 Winston Ct
5772 Melton Road
2063 W 1250 S
1716 Sheffield Avenue
1111 E. Main Street
2200 E. 88th Drive
2619 Main Street
10 Lincoln Avenue
5777 Cleveland Rd.
700 Schiller Avenue
P.O. Box 41
P.O. Box 450
Schererville, IN 46375
Portage, IN 46368
Hanna, IN 46340
Dyer, IN 46311
Griffith, IN 46319
Merrillville, IN 46410
Highland, IN 46322
Calumet City, IL 60409
South Bend, IN 46624
Schererville, IN 46375
Kentland, IN 47951
Michigan City, IN 46361
(219) 322-2300
(219) 763-9700
(219) 797-4004
(219) 865-2961
(219) 924-6972
(219) 756-2200
(219) 924-1623
(219 )932-1611
(574)271-7800
(219) 322-8090
(219) 474-6542
(219) 872-8605
(219) 865-0065
(219) 763-9703
(219) 797-3008
(219) 865-2963
(219) 924-1401
(219) 756-2202
(219) 924-0328
(219) 932-6829
(574)271-0524
(219) 322-0031
19) 8795339
3113 Holmans Lane
Jeffersonville, IN 47130
(812) 725-8665
(812) 725-8672
13476 Britton Park Rd.
Fishers, IN 46038
(317) 841-8364
(317) 841-0075
6200 W. Hwy 62, Ste 400 Jeffersonville, IN 47130
(812) 282-2751
(812) 283-9846
209 Quality Ave. Ste 9
New Albany, IN 47150
(812) 941-0252
(812) 941-0852
9350 E. 30th St.
Indianapolis, IN 46229
(317) 594-0291
(317) 594-0271
1850 E. North St
Crown Point, IN 46307
(219) 662-8090
(219) 662-8093
1620 E. Chicago Ave
East Chicago, IN 46312
(219) 397-4444
(219) 397-8888
25020 State Road 2
South Bend, IN 46619
(574) 287-6490
9111 Louisiana St.
Merrillville, IN 46410
(219) 769-6007
(219) 769-0565
4601 Cleveland Road
South Bend, IN 46619
(574) 272-9673
(574) 271-0144
1850 E. North St
1620 E. Chicago Ave
3122 Olympia Dr
24963 U.S. Highway 20
1810 W Pacific Avenue
P.O. Box 526
7440 W. 87th Place
3122 Olympia Dr
24963 U.S. Highway 20
1810 W Pacific Avenue
3542 Highwav Avenue
3122 Olympia Dr
1810 W Pacific Avenue
3542 Highway Avenue
P.O. Box 235
210 E. 113th Avenue
125 Montgomery Street
8253 Wicker Avenue
Crown Point, IN 46307
East Chicago, IN 46312
Lafayette, IN 47909
South Bend, IN 46628
Knox. IN 46534
Rochester, IN 46975
Bridgview, IL 60455
Lafayette, IN 47909
South Bend, IN 46628
Knox, IN 46534
Highland, IN 46322
Lafayette, IN 47909
Knox, IN 46534
Hiahland. IN 46322
Dyer, IN 46311
Crown Point, IN 46307
Logansport, IN 46947
St. John, IN 46373
(219) 662-8090
(219) 397-4444
(317) 780-1825
(574) 287-2078
(574)772-7001
(219) 662-8093
(219) 397-8888
74)772-7002
(574) 223-5817 (574) 223-7959
(219) 864-2300 (708) 430-6910
(317) 780-1825
(574) 287-2078
(574) 772-7001 (574) 772-7002
(291) 746-2433
(317) 780-1825
(574)772-7001 (574)772-7002
(219) 746-2433
(219) 322-7033 (219) 322-4419
(219) 662-9911 (219) 662-6206
(574) 722-3102 (574) 722-1628
(219) 374-9900 (219) 374-9950
V ARDRAIL/I::"ENCING
Acorn Fence
C ..I'ech Corporation
James H. Dreg Company
Security Industries
Specialties Company
IT TRUCKIR6ALIN
C. Lee Construction Services
Condon Trucking, LLC
I:: anio Services
GilmerTrucking
MaterialTransfer Inc.
Morris Motor Service„ Inc.
P & C Trucking
Superior Construction Co., Inc.
V R 'trucking, Inc.
..........................�................................ ..
DAM"
K & S Markers, Inc.
UNDERSEAL
Rie'th-Dailey Construction Co.,
I no.
TREE REMO�WE—
Dave's Tree Service .. _............._
Horner Tree Service
Timber Masters LLC
- -LIMA: STABILIZATION
Mt. Carmel Sand & Gravel
Rock Solid Stabilization
Specialties Company
FIFE LINING
Indiana Reline, Inc.
SAW CUTTlNG
Diamond Coring C0., Inc..........
............................_.. _........_---
_...
ualky Saw Seal, Inc.
-mSEAL COATI N / 'TRIPING
irte Services, Inc.
Blackout ealcoating
_.. _ .._..�....�.._ _ ... ._..
DIVD RDRAIN
3D Company Inc.
2041 164th Street
5300 W. 10 Forth
6701 Zionsville Rd.
1000 Ceorgiana St.
9350 E. 30th 5t.
Hammond, IN 4 320
oggston„ 146110
Indianapolis, IN 46266
Hobart, IN 46342
IndianaDolis, IN 46229
Cary, IN 46406
Portage, IN 46366
South Bend, IN 46626
2169 N 600 W Thornto n, IN 46071
2454 West CR 450 North LaPorte, IN 46350
1555 Dark Vest Circle
14000 S. Archer Ave
P.O. Box 245
312 D. Main Street
10117 Kennedy Ave
7440 W. 67'th Place
3200 East CR 350 North
Munster, IN 46321
Lockport, IL 60441
Dyer, IN 46311
Mt. Carmel, IL 62663
Ringwood, IL 60072
Indianapolis, 146229
Sulphur Springs, IN
47366
Chicago, IL 60617
rid6eview.........._._.4._W.....����........wwwwwwww.
IL 60455
Highland, IN 46322
ridaview, IL 60455
Muncie, IN 47303
(219) 644-6441
(317) 63-2761
(317) 676-3629
(219) 942-9446
(317) 54-0271
PfIaffo:i►a' m
i
(765) 766-5040 (765) 533-5631
(219) 924-944
(219) 664-2300 (706) 430-6910
(765) 236-3326 ('765) 266-3344
7
General Form No. 96..rca.
Prosedbed, by the State Boaxd of
Accaanaen4s of Indiana, Revsed 1949.
Standard Questionnaires and
Financial Statement for Bidders
Prescribed by
THE STATE BOARD OF ACCOUNTS OF INDIANA
For use in investigating and determining the qualifications of bidders on public
construction when the aggregate cost of any such work, or improvement will be Five "17housand
Dollars or more.
These statements to be submitted under oath by each bidder with and as a part of his bid, as provided
by Chapter 306, page 1248, Acts of 1947
Submitted to , Cimof,wSouth Bend.,.Indiana
By................................ ---......... ..........._............Walsh.&_Keller, Inc.
Address 2,4358 SR 21,,,South,Bendw IN 46614
Date submitted
Filed
A.E. BOYCE CO., MUNCIE, IND.
IA Corporation
1
Sec. 2 ofan Act entitled "AN AC"I'concerning the awarding of contracts for the performance of ptiblic work and authorizing
the board of accounts to prescribe certain forms to be used in ascertaining dw responsibility of contractors who submit bids for the
performance of such work, providing for plans and speci.fication,,.s, providing for bids repealing certain laws and declaring an
einergenc,Y 7 (.Approved March 13, 1947.)
See., 2. Wlienever the aggregate costs of any work or improvement will be five thousand dollars ($5,000.00) or more, for the
purpose of enabling such board, cornriiission, trustee, officer or agent to ascertain arid determine which of the bidders submitting
bids Farr the performance of any such public work. is, in the judgment of such board, commission, trustee, officer or agent, the lowest
andJor best bidderand to exercise intelligently the discretion hereby conferred on such board, corrunission, tnjstee, orficer or agent:
each bidder shall. be required to subirdt under oath with and as a part ofhis bid a staternent of his experience, his proposed plan for
performing such work and the equidpirient which he, has availaffle for the performance of such work and a financial staternent. The
statements hereby required shall be submitted on forryis which shall be prescribed by the state board ofaccounts. The forms so
prescribed shall be designated, respectively, as the experience questionnaire, the plan and equipment, questionnaire and the
contractor's financial statement, and shall be based, so far as appficable, on the standard questionnaires and financial statement Farr
or
bidders as approved and recommended by the joint conference on construction practices, for use in investigating the qualifications
of bidders on public construction work, and the forins, so prescribed are hereby prescrilbed as the forms which shaU hereafter be
used by all such bow-ds, commissions, trustees, officers and agents in obtaining the information which N required in the
administration of this act. If the infon-nation submitted by any bidder on the forms herein prescribed is found, on examination, to
be unsatisfactory, the bid submitted by such bidder shall not be considered. (Burns Statutes 1933, Sec. 53-109) See. 2, Cbapter306,
Acts of 1947,
2
Y 1161191 ai Wimp 1 A14M
The following forms of questionnaires and financial statement are prescribed by the State Board of
Accounts in conformity with the statute set out on the preceding page.
These forms, properly filled out and attested, must accompany each bid of five thousand dollars or
more on any public work.
The forms are designed to cover all contracts for all kinds of work and the bidder is required to answer
such questions as are pertinent to the work upon which he is bidding. The purpose of the questionnaire and
financial statement, as set forth in the law, is to enable the awarding body to determine the qualifications
of the bidder to carry out successfully the contract if the same is awarded to him.
The bidder will find it to his advantage to answer fully all questions coming within the range of the
work upon which he is bidding. Particular attention should be given the "Financial Statement" and the
details relative to the assets and liabilities set out. This form is made in extensive detail so that the bidder
may explain his assets and liabilities in proper sequence and in a uniform manner.
T. M. HINDMAN,
State Examiner
Submitted by ............................ Walsh_& Kelly " Inc. ---- — -.--...........------- ....... { x A Corporation
p 1700 East Main Street,_Griffit„ 6319-1
Principal Office at _ __...... ., IN 4
To,...... City of South Bend, .Indiana _
EXPERIENCE QUESTIONNAIRE
The signatory of this questionnaire guarantees the truth and accuracy of all statements and of all answers
to interrogatories hereinafter made.
4. Have you ever failed to complete any work awarded to you?, _._No.....___If so, where and why?
Has any officer or partner of your organization ever been an officer or partner of some other
organization that failed to complete a construction contract? No .,If so, state name of individual,
other organization and reason therefore„ ........ _._
6. Has any officer or partner of your organization ever failed to complete a construction contract handled
in his own name? No ... If so, state name of individual, name of owner and reason therefor
7. In what other lines of business are you financially interested?
For what coq)oration or individuals have you perfon-ned work-, and to whom do you refer? —
BP
Tonn & Blank Constrixtion 1623 Greenwood Ave. 46360
. ......................................................... . . . . . . . . . . . ........................... . . . .... . . . ........... .,Mi hi an,C ty-IN
1 111-111K,-_6 -, - -A ..................
-- uiC. nc. 261M---tGrinim-eCnstrcto--am_ l-ligI&q0N322
I I ................ . . . . . . . . . .
[Jnivef slil��,,,o�fN,ot,r,eD..ame,5gl&_
Gough. Inc., 1151 SummI.CrownPoint-IN 46307
. .. ...................... . . . . . ..E. ........ . . . .......... . . . . ........... . . ..................................... . . ................ . . .................... . .................... . . . . . .......... . . - - - ----- --------------- . . . . ..... . ............................. . . .
9. For wgnat cities have you performed work and to wbom do you refer?
Town of Gflffith
-1-111-1.111- . . . . . . . . . ........................................................... . . ............................................... . . . .
................ . . . . . . . - Director of Public Works
Griffith IN
Tolwll of Schererville — - --------
I J_ I own.-Manao . ........ . ...... - —
Schererville.1'N
--------- - -- - I-P .................... .
City of Hammond
. . ........... ..... ........ . . . ____
j,1I-a1m1qiQn0L]N
Ciry of South.Bend
-.Jo
Cil. Enj;jnr I ee
........ - — — ------
South Bend., IN
Fo�rn o'f' S t'.' h- n
---I'll, . .......... . . . ..... - ------- - -----------
T ovai. ---------------------
St.John..[N
---- ----- ---- - ---
10. For what counties have you perforun ed work and to whom do you refer?
Lake County ........... . . . ...... . .
11 ...... . . .....................
Hi, Iwav-SI -rime
. . ......................... . . . . . . j- -_,- - _41� --- _-q- -_-- __
Crown Point, IN
-_ , _ ..... __ .... . . . . ..... . ................. -----
Porter
St-losp ph County
11 , Sq )erintendent
............ . .... . . ........................................................................................................................................
South Bend.I.N1 ...............
Ellairt Can Y... ........................ -----------------
jfj,a y. S wrintendent
u-�—
Elkhart, IN ------- --------- - - - - - --------- -
LaPorte County - - - - ---------- ------
Supqryu� ----------------------
Lapofle� IN
- - ..... . . .................
11. For what State bureau% or departments have you performed work and to whom do you
111ndJ4n,a,,N)artrn eP t of Tran-spoftion LaParte District LaPorte I.N
Qppartrnent of Natural Resources 1xidian
. ................. W . . ........ . . .....
12. Have you ever performed any work. for the U.S. Government Y'lells��'ll. .....��������l", ....... ... ................................... . . . . . . . . . . ......... .........
If so, when and to whom do you ref-br? ... . ....... . ........... . — - - ------
I.I.S.Arn C rps IV 0 4 of)Enu Ilmers ....... . . ....................... . . . ..... Chicago, IL
Indiana ional Guard. D f n In noun ,-FN _pjjt.,g_Admjnistratio
... ........... . . .................
Federal 19u �-Adminjstration Sterling YA ...... .......................................... . ....
13., What is the construdion.
ex erience of them
L)
individ
al ofyou
m organization? - --------- ------
INDIVIDUAL'S NAME
PRESENT POS.FHON OR
YEARS OF
MAGNITUDE AND
INWHATCAPACiTY
OFFICE
CONSTUCTION
TYPE OF WORJK.
- -----------------------
EM"ER-UNCE
........ . ...... ......
.Kevin.J. Kelly
President
33
A.H_Tvpes� . ......... . ...
General
lnm
_JeIf I ,,".Swan
E.xe. c.-u....-tie ..... V i c e res ident
.....P....
34
A I I T). eTs
.
.................................
SupAEnj" neerm
David J. Misirly
Vice President
33
Biturninous
Engineer
- — ---------- - -------I -------------- -
P ,
......... . . . . ...............
Greg A.11offman
Vice President
31
Biturn inous
Engineer
Pavia.1 - --------- - -----
John C. Wall
Vice President
41
All i2q,
Eq�pnecr
John M.. Jensen
Vice President
33
All t�j�e
General.Man4�pr
J.Michael
Secretary/Treasurer
.
46
......................
Administration
General Manager
Schaum.
Jamie I.... Tancos
---- - --------------- --
Controller
---- - - ---------------- - ................................ ............................... . .... ..
. 14
Administration
General Manag
per
South Bend, Qps.Mur
23
All i pes
En a incer
.... ..... . ....... . ....
Dustin.p. 1-fil"nj
.................................. . . ............................... .
. . ... . ......... . . . .... ..... .........
South Bend Area JWff
.........................................................................................
. .......... . . .......................... .
18
.................................
All � v
yL es
Mark E..
Engineer
28
All types
Engm.eer
Krachenfels
Keith A., G din
Enoineer
.
. ................ . LyPe § ......... . ...................... .
. . . . . . . . .................
...... Engine er
Nikolas G. Relias
. ................ . .....................
jneer
16
. . . ............................... ...
Bituminous
. . ................... ..... . . . . .............. .... .
En -me Ir
�eeeeeeeeeeeeeeee.a. - -- - --
Pavm��
PLAN AND EQUIPMENT QUESTIONNAIRE
The signatory of this questionnaire guarantees the truth and accuracy of all statements and of all answers
to interrogatories hereinafter made.
1. In what manner have you inspected this proposed work? Explain in detail.
Plans, Sj1ecifications. and Site Ins,��)ections
2. Explain your plan or layout for performing the proposed work
As directed by owner/engineer
3. The work, if awarded to you, will have the personal supervision of whom?
Kevin J. Kell° � Jeffrey L. Swan, David „J„Mis rly., Grego' � A Hoffman,_ Dustin_P. HiLt ��,_and„Lynn,J,
4. *Do you intend to do the hauling on the proposed work with your own forces?,Yes WW,
If so, give amount and type of equipment to be used As .needed
5. *If you intend to sublet the hauling or perform it through an agent, state amount of sub -contract or
agent's contract, and if known, the name and address of sub -contractor or agent, amount and type of
his equipment and financial responsibility,,,
Items 4,5,6 and 7 may not be applicable in all building contracts; if not, omit.
6
6. *Do you intend to do the grading on the proposed work with your own forces?
If so, give type of equipment to be used
7. *If you intend to sublet the grading or perform it through an agent, state amount of sub -contract or
agent's contract, and, if known, the name and address of sub -contractor or agent, amount and type of
hisequipment and financial responsibility.................................................................................................................................................................................................................. --- —-----------
8. Do you intend to sublet any other portions of the work? __._If so, state
amount of sub -contract, and, if known, the name and address of the sub -contractor, amount, and type
of this equipment and financial responsibility ..
9. From which sub -contractors or agents do you expect to require a bond? None
10. What equipment do you own that is available for the proposed work?
QUANTITY
ITEM
DESCRIPTION,
CONDITION
YEARS
PRESENT LOCATION
SIZE, CAPACITY,
OF
ETC.
SERVICE
5
Asphalt Plants
Various
Good
Griffith, South Bend,
Vallwaiso, Lowell, LaPorte
19
As .halt Pavers
Various
Good
Griffith, South Bend
4
Slipform Conc. Paver
Various
Good
Griffith, South Bend
3
Road Widener
Various
Good
... ........
Griffith, Sou
5
Motor Graders
CAT/J.D.
Good
. -- -
Griffith South Bend
5_4
Rollers
Various
Good
Griffith, South Bend
30
Rubber Tire Loaders
Various
Good
Griffith, South Bend
_15
Excavators -----._...
Various
Good
Griffith, South Bend
9
Bulldozers
Various
®.
�......
Good
...
_
Griffith, South Bend
...._. .......... .
6
LowBoy Tractors
Various
Good .._.. .-
- _____....
Griffith, South Bend
.
8
.... .........
Flatbed Dumd:s
.._.
Various
Good
_._
Griffith, South Bend
48
— - —
'h and 3/4 ton Pickups
_ .. _.. ..............
Various
..............
Good
......
., .....
— —
.... .") ...
Griffith South Bend
_..........._.....................
65
1 Ton Crew Trucks
...................... _. ..
Various
Good
Griffith, South Bend
3
Cold Planers
Wirtgen 1900
—
Good
...................... ......._.
Griffith, South Bend
DC
3
TrI Axle Dumb
Mack
Good
South Bend
12. How and when will you pay for the equipment to be purchased?
13. Do you propose to rent any equipment for this work?No If so, state type, quantity and reasons for
14. Have you made contracts or received firm offers for all materials within prices used in preparing your
proposal?
Do not give names of dealers or manufacturers,,,,,
Dated at ........_ South, Bendthis 1,4t'',,,,,, day of April" 2020
_Walsh & #dell Inc.,
(Name of,OrgpizatioI
° B
E a y.„ _
�=�stin Hilaa�y,,_VP_of S,
` � �° "itle of Person Signing)
STATE OF Indiana_..___
Iss.
COUNTY OF St,...Joseph
Dustin Hilaf __ being duly sworn deposes and says that he is VP of South Bend, Area of the
above , Walsh & Ke11 x I..nc.
(Name of Organization)
and that the answers to the questions in the foregoing questionnaires and all statements therein contained
are true and correct.
Subscribed and sworn to before me this e 14,`,------- day of APfil, 2020.
Alisha Krklet Notary Public
M Commission expires June 5� 2022
Y p AL
KRUEC R
SSF
PubtiC, Stilt® Ct tnJ+and
Nataod
8 �. c =e
St. Josopr county
. SEA � �
y Cornmiss:an c/p'irels
lJ 1iYviMv,1
WJ'U�.'4�xiuif'Xr
N
Ij ne x
The name of the partnership firm under which the above partners are operating is
Give names and titles of all persons having authority to execute and receipt estimate vouchers and to conduct
other business for the partnership, the signatures of whom are legally binding.
The undersigned hereby declares that the foregoing is a true statement of the financial
or corporation herein first named, as of the date herein first given; that this statement is for the e:
whom it is submitted to award the submittor a contract; and that any depository, vender or other
to supply such party with any information necessary to verify this statement.
NOTE: A co -partnership must give firm name and signatures of all
partners. A corporation must give full corporate name, signature of official
and affix corporate seal.
the individual, co -partnership
3e o nducing the party to
- amed is hereby authorized
`�% ,liar s/1BE���
Affidavit for Individual ,®It' µ ° '���
STATE OF ®V O R/q ,
ss: c
COUNTY OF °
..........
.......................... ... being duly sworn, deg ses
foregoing financial statement, taken from his books, is a true and accurate statement of his financial condition as the to thereof d
that the answers to the foregoing interrogatories are true. •°°°®®
°°
®� ® I 'N
(Applicant must sign here)
Subscribed and sworn to before me this
day of 21
Notary Public
Affidavit fear Co -Partnership
STATE OF
SS
COLfN l`Y OF
_ m ... beini daily sworn„ deposals and gays that lie is a
inember of the firma of : that he is familiar with the books of the salliG.'R.
iinn .showing its financial condition, that the foregoing financial statenaent, talam,n from the books of the said. firnn , is a true and accurate
statement of the financial condition of the, said firm as of the date thereof and that the answers to the foregoing interrogatories are true,
Subscribed and sworn to before me this
........day of ....... .... ....... ........ _ 20.
Notary Public
STATE OF Indiana
(Ml:ernber offirm must sign here)
Affidavit liar t:;orporation
ss
t:lDasN� �lOF� St -Jq elu .....
being duly sworn, deposes and says that lie is,. VP of South Bend Area,'.. -`the Wals�l. cll� lnc
e financial
,r 1 . ra .
tlae corporation described iiii and nrwh�irli �si,cuuta,d the �foregoing �tata,urierat;that. Pia, is laimbli~ i utt7 the boo��'nl ttac said corporation showing
its financiall condition, that the foregoing financial statement taken from the booker of the ;mid cofi:aort( n.., is a true and accurate statement
of the �hirnmcial condition ofsaid. corporation as of�the date thereof and �diaat the an i�x'io the forepr interrogatories are trmae.
Subscribed and sworn to before rrue this
14th
Alisha lilre'eger, Notary Public
KRUEGER
Notary
LISHA
Public, StatO of Indiana
r,L
St. Joseph COUnty
ati
hnY Commission Expires
?ir \
JurleCi5, 2022
�IXWIiiN G2F''�➢4wew IMPWII
,uKe^�.�' b�ayW% 9;.
�m'N �.A:�IDA
(t�lfilt l must sign here) Dustin 1-Iilairyr, VP of Sou jea
�K EC<
r �Qu1RP0�AT�C ®C`1
15 ����tRtttttt��