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HomeMy WebLinkAboutWater Service Agreement - Construct a Water Main from Four Winds Casino to Star 001 Property - Star 001, LLC.1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND, INDIANA 46601-1830 CITY OF SOUTH BEND JAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS April 14, 2020 Ku1j it Singh Star 001, LLC 14612 Carrigan Ct. Granger, IN 46530 .cot-n; .5. ! is ri �.fl.tdigs04 rnaj],�corn .. ............ ........... ........... ......... _L,� RE: Water Service Agreement Dear Mr. Singh: PHONE 574/ 235-9251 FAx 574/ 235-9171 The Board of Public Works, at its meeting held on April 14, 2020, approved the above referenced agreement construct a water main from Four Winds Casino to Star 001 Property. Enclosed please find a copy of the agreement for your records. If you have any further questions regarding this matter, please call this office at (574) 235- 9251. Sincerely, s/Linda M. Martin, Clerk Enclosure GARY A. GILOT ELIZABETH A. MARADIK THERESE J. DoRAtj JORDAN V. GATHERS JOSEPH R. MOLNAR WATER SERVICE, ACREEN/lENT' Rds Water WrOce Agreement (-'A�rccrnerit-) is made on The (hly OFMI,,. 20,)o by and between the liar 008. 1 J.Q a donwsUc hmiwd AN% company, wilh it.s principal place of husiness located at 14612 (I"Wan (7oud, (Onger, ladiana 46530 (.WW) and Te City of' SOUth Bend, Indiana- as n-itinicipal coMomdon eximing unda the la%vs of Indhni, acting by arxi thl'OUgh its Board of' Public Wod� s (-Ciy") (eadi as -Pany- and Wectively referrcd to herein as the "Parties"), MUNWAT O"ver huends to develop the Waldo I lon,iestcacl Minor Sufxfivision (-Cal,aldo FJOTI'lestcad"). loc,,,,aed ,.it 3325 Wide Avenue (Swe Route 23), South Bend, Indiana 46614. car fisting of a devOopmenl ama of 91 acnas PH the conimerdal purpose of consvucdn,,,., a convenience sl(we and gas Matron. as LkPiCted, on Lxhibit A, incorporated herein by reference amd aunhn-ica and WHEREAW (Mrier dadws certain commim-tems himi die City. in i,egaiall to weruhng and amkhg addhhns w be eximing Ymcr systern ("Systen)") to serve said dcvelopntent; and WHEREAS., the (niginecriqg desigri for said Sysimin has been, orwill W aca-anplished by- cornpetent professionW enoneas nTinered am! 14crised in Me WaRs or Indina; and WHEREAT Ownet undasmals the existing sc-wer latcnal extending from the Owner's f)N)lX,Tt�V LO the flUblic seNrcr on New Energy Mve is considaed as private sardiarw latena.l (See, 1N't-tihilt-1 . inCol-f)onated by retbrence and machinent): ark ?sowni EREFORE, in cc)nsicleratjoni ofthe, obligatOns, ternisand conditions contained her6n, the adequacy of' M-ticAi the Parties expressly acknoMedge. Owner and the C'ity agree as 011ovVS: 191NINFUHNIMUMMIR Ile Pates haelo acknomiledge and agme At the rochals set Ira h above axe made part ofthis Agreement f6rall f)LR"j)OSCS, The (Kner has pRnided A (10, w,iffi design plans as described kvithin t`\ Awoqvratcd herein by rebrence and attachnient. vdiich depicts dw poposed Symem. IN Oty acknomdedges the Systeni, as depicted in , -C.. confinns to the City's Stanclards. Th�., City, shall approve the Mgimtion of be enghwer w4o skill he responsible forth cripineering dcsiEui and inspection in connec6on with the inmallai-ion of sAd Systeni The Owner shall Inc ivsponMble to faro %,,ide irrspcc6on dMing consirtiction and to cmsmv the coginecr's conOrnumce to ama p1modrig, adequacy of desi➢w n. an(] confiwrmance for Chy recptimnwnt, repi-Ang WaM ske and depd-t of Me. capacity, suid qualy of uinstrucHom The Owner shall alloNv the City to inspcct the systel-n con struc ti oil to ctisure conflormance to the agmed sWrthwds set f`ooh in E,\16hit C. 'I he (Kner shohl contact the City's Engincering Depannient tit least M) (2) hushmns days in advance of consluctkni commencement of the Systen-i to arrange J6j- the attendance oh. as City inspectol". The Owncs shall contact the City's Water VV(,,)rks Department at Je,ast two (2) business days in advance of' lesting, of flic Svstem u) arrange Rw the Wndance ol as City Water Works smff-. 'I he Owner agrees to perform any necessaTy adjustnusnis as reammaht reWtircd by dw G, it"he We, dkcreW)n of the 01 Wgirwm- or 1wr desigr ee. zts a re�,,;ult ol'such inslicctions, 11c Owner shall In-ovide to the (a:" ty a statenicnt Ifoin ffic j.-)rqject en-ginecr cerfify-inn tfifl the Nvorkn-tansfiip and ln,,,Iterials� including pipes, bedding. thrust blocks. v,alN,cs, fire hydrants, inadioks. and Wi rAmcd nhucdalk ilim the Ciq's specificAms and swnherds, Uy)n xvriuen request Whc Cly. Te cendkodimi shod! No substandwed by nnuerial afflidavits froril SUI)Ifliers and b is pplicable tcsts Or deflect5n, pressure. leaks. KIM, conqwclion and other tests as inay be: required by the (1t:it'. AH ummudW engineering and inspcction cost in cc: ntrection �N)ith the Systern shall be borne, by the Owner, tjon cmnMrmnon completion and successM tesOng, of tire Syslern. C)",ner agrccs to [,'Provide, �varer "As-BLIih," dra%Nings, to tile (.."it), in accordance with the C,'dy of South Bend prev,aihng, SPORUMMS fair Nblic Mwks. "Itch inay be lbund M in The Whire of (Inner to coinpla,,, with. any of the requiernew wilin thk ScOM 2. shall congiMe as rnalCHM WK or dis Agreernew, 3. renwjL� It shall be ()"nc& We rnp(mmIddy and at Ch"eCs expense lo obtodn any zind all (1) and State pennits and appmv& assochMed Wth the conStrUCtiMl and instahation ofthe Systeai and to Coniply with tall p�ipjflicable IaNvs. rq .!ukitions, and rulcs. It AN! he the OwneCs reMNWHOty and M (Mm"s cxpense to obtain anand all per aaaacwl approvals, associated w,vith the constructhm and inmaHadon orme ystun on private property , 4. s Esthnates EAlaingify EyAniate The Ovxier shall provide an Fngineer's Winiate is INhi J.), incorporated herein by reference and artachilret'it) for the cost it.) consirml the SyMem, indwhng lot not AW lo, exc avation. jApe rnaterials., v,,.itvcs. hydrants. and all other aIppurteniint rnaterials,, SLIPI)IieS a,ruid cWdpmerrt. pennA Wes. backlill and bedding, pavera ent. rcstor,ation q,,)I' the areas, inlpacwd by consovehon to a cmWiGni Whe smne as or tatrer than exkwd prior to consHoction. W any (Aher work requhvd Ar the SqNnn. Nior to the c(mimencemwrif (d'anv x(wk by We (WnCl Of- 0AflCr'S C0F11rkCt01'(S) , 0WI-M' shaH Inovide the Gq with a peribmiance sureq bond (Sm. Fx&Q Ek inwrtxwated hervin hy, refi-re,nce and awachrr)(11t) fi,)r U11 cinIOU111 cxltrad to one WNW twmAy five pervent 025%) of die JrjdLj Ownet's enghee& emhume for the vvork to ire pert 6nrlled U this Agreernem. Upon the ismiaArwe by tile City Of a Pro�jeo conipi(.,ption Nnidavil, the (Awner's obhgation to andwain the hond shall cease wilout any WAY a0ion by or codham6on hvm fire Cly, Re (AwWs RdhHe k) pnwkk Me hond as raph,ed herein shaft cause this Agreenient to he W and VOK %iTOLH the requirement ofnAce lhn-n the 0t, 6. Alai nUzanARA rety_11onxi Within fen (10) days ofUly's acceptance ofAcdicat)n of the Syman,C)"nershall provWe lie ( ly Nddi a riNdmemnicc sunaty bmid equal to ten percmit (I WA) of the Owner's engincer"s Wnwre orthey work perli)rrned under this Agmemea and such bond shall iemiiin in c1lect for three (3) years k0owNg dedlodon to the City. as descrVed in Section 9 o: 'this �ddreerrra rat. 1�11VGWM Wept as (AhervOse jwovisle d Iwre n. the term of this Agreernent shall corttiruw froni the imetive Dale listed abiwe LHAR all Of (ATICt's oblWations urider this Agreeaic.,nt have been sa6sfied., inclutling but imi Jimited w (10 review and approval of"As-Builts" tan dedication of tile Sy"Acin to tile S., Dev CIL) For purposes of INS .Awn 8 or to /vrecnrent, an ( �qt%deiv residenthd unh (IRIT' ShaH 1-nean a single-fianidy residenco I& cmunners that are trot single farnil� residcrices, one FRU shafl equa] emirnated inslewaWr and wer Oows orTO gallons per day. rcspcctively, I'o CUstonier wiH bc, less th.an oric F'RU,1. For every new conne0ion to the Smidt [lend Munkipal Water "w orks. as system developmern chmpe of 6ve hunTA dollars QWKWO shall be cullected per ERLJ ouid addithinal por6on 0'wereoflo he cNnwoed. AH charges CA be hHQd hy the City at the We the appikation Wr sowice is RledFor all other lypes of smuctures, the ERI I C<IICLIkLltiou SN'111 lie based upon the moo or Pacne Daily Flc, Nm as computed pumum to 327 1AC T& I I in relwkmship to Wee hundred ten (3 10) gaHons rwr Q. Wr structures M listed in 327 LAC 3-411 Ahe INU W he c%davd as the relaWniship lwvwcen the Wrage IbHy llo%v repMed in the water capacty cemiHmion for It structure and We hun&cd ten (3 10) gaHons per day,, F01r CWA,0111ef'Si width ganter Own Wnty (20) IT,.1 is as caICUkMed pumum to subse0ion (4 1 ofthis section, the FRt j AN] be aQusWd Wed upon Ke flaking Ficum, as amnaed Wrek. 'I Fic ITAing Wcwr shall be cakulated 1)), divicfiny.; the Peak Daily 11ov by the Avemge WV [low, both as reponed in the wMer capaNty cerAk ado w In no evo-i I wi I I a PcakinM ,! Factcwr I than, 10 he usM Ar puMoses or the a4justment described in dos subsection. The Peaking Fa,ictor, divided by 4,0 (the Peaking Wor Rw raddential kwnnecOons) wAll be muhioial by the rnmaher of IAU s for purposes ofccmuputing the systen; clew elornnout chwge o"A by the cusUmner. The City Board or VAwks may exenve a coiaract Mth the customer awhodAmg an incNasc H) the MY Syman Devclolmnent base(] upon aeRMI Mage data that is collected after c"onnection. 'lit: receipt oF11w Symn Dcrveopment ChmTe and Mity Verihcatiora Fec, is provide(] in -1 Jhhh E iworMmMed 1wmW brekn-encc and atlachrric,,nt. 9, and Dedication Ile Synov shW1 he unstructed MTV an exising easmireni on pHvMc priMeMy and SM of findian,a Right-of=ay as depicted in Exhibit A 11 1 1-1- . ........ . .. - Owner agmes R) pmvMc '"As-Buills- Or Cly, review aimi alAinwal wid dedicale the completed Syswni to the Oty, 10 kL Cation Owner agrees to hold harnfles,,,,,,. fildcnlrjityand detirid the City. its agents, ernployces, succc.ss(rrs, add assigns Adlectively the -Indenmitees-),, ,.,igainst ztny ckdni, action. loss, cost, dan-lage or expensQ. ol, whatsoever kind or ruiture (including bUt 110t 11' VviY 01' liflliftfliOil, attorneys" fees, and court c(ans), all the kwcgoing heing a "C'hik'n" h1-0Ugtn, by any person or enfity Wng W of this Agr. een-lent char~ than those (Urns King Mch, oul of the EVoss neglIence 01-MlIfill. n1i"Conduct the City. A ag4.'rA4 eMPJO),CCS. SUCCessor's, and a'rssigns, 8Iction k Sought agahm the Inderninkes in connectimi xvith, this Agrccinem. (hvner agrecs to (,Uend such action or lwocceckgs at A (nvn expense and to pm y any judgment rendeired dwreh. IlAnsurance Owner, at (Knet's sole expense. shall maintain during Itx tenn ofthus Agreernetu cornnwW-11 ,genend hability inanance in an anwunl ium pc ss than Five Million Dollars (5,5.000.000,00) pacer occunencs (Ancr a.pr(.,es to AM the Uity as an addWoiwl nwnwi Nswvd on sudi pAky w(] provide, the Chwith as ArOMmic or lnwra,nce cwidencnig the same (See, [-,) , h "' spat - j,, incorporated herein by relbrence anxi auachmcnGr It the exwni At the City is htrnu,d as a result of lhc, Ownc& connewhin to the Oq's wwr qwnt Owma hemby grwAs the CRy thst Quity (in any proceeds received from Owner's insunince. QuAthsWnding anything! in this Agreenwrrt to (Ile contrary, the (11 Aws not %Wve any govannwnwi hnmanhy or libility Wirnitabowi availaNe under Indiana law. 1 �2. wp,EkmWpp it I his Agrecwment nmy m be assignod by the Owner Vvithoul the express wvritlen consent o'Ire My, which may %Hhhold such consent liar wy reason. Any MW or dis limitadon Qdl ternihiale the City"s oblipions hereunder and forleh the Owner's righAs umkT US Agreement, 13. Material Breach The Parties agree flial, as maledal breadi orthis Agreement by Ovvncr wmild have as Imaterial adven,'e el'fecl 11pon thc 01y. The Cli, AM pmvidc the Muct, with wriucni nofice (A'a material breach and [amide the Owner vvhh A (Tponuky to mov such del"auh vithin thirty (30) days M' the date of receipt of Tumve flom We ( 11. Upon katlure 1')v Ovvner to cure the hreach wvifllin ille aHotted finieffiaime. Or it' (11C bl-C�1(11 iS iRCLHAWC, the City vn""Iy hillnediately tera-tiriate this Agremuent immediawly LWon pnoiding %Atten mW0ce to (er and may call (m the Perlbrmance Boiut ear iKKr Li This WH he g(mmed and construed in accon1wice NOT the laws orlhe State of lncfiana, Any legal acdon lbrimaEly kwought by one Phrly against the-odwr shaH bc inithited in the Sime 0mms orSt. Jcr scq)h County, lndiami, irany pmvidon (dads Agmement is heki by a court c)['coinpelen.1 jurisdiction to be invalid or i.men('('-)T'ccaHC' such unenfbrcc:,iblc provision be deemed severed from d-w rerndrideroC this Agreement and shaH not cause the remainder (if this Agreenient to he invalid or unent1mveaMe., 11 any provision. or any portion of any pnwidoin, ofthis Agreement is deenied invand (ILIC tO otS sc(qN: or hreath, such pmviskm shall be decmed Wd to that extent 4' 0,1(:, scope or hre,idth Peri-rinted by 16. Hiis Agrecmciil contains the entire undcrstanding and agreement (,)I' the Partics hereto and suposedes all Whor prior agreements and undasmnWngs, vvrirren or oral between the 14rdes. 17, , rq!iL , Arm r 1, S �jLKizafiqq and CounQ111111 F',,.icIr person siy..,zuing Ar an MQ wanmAs IOU she or he is di-dy aMthorized to do so, This Agreement may he execuml in comumparts. aH of Which takeri together shl all constitute one dockinleni. (RenuhnAr ejj?ir,�'2c bactilional4v /efl blank) IN WITNESS WHEREOF., the Owner and the City, thrw.xgh their dUly at.ahorized representatives, have cat.ised this Agreement to be exect.aed as of the day and year first written above, The Parties have read and Understand the ternis of this Agreement and do, by their respective signatt.wes, herelby agree to its terms. STAR 001, LLC CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS Byi ..................... I)rinted- .............. BOARD 01,11 iBLICWORKS fftle, . I ... AE -N ... . . . . . . . .... ..... .. ............................. . ........ A. (Mot, 11—i&.1 hImAdh A, Nl..dik, Member Jor&n V. (Mlh—,Me,nb. A,wphRAM-, M-1— AFIFSF Linda.M. Mnm Ml mwm�� CATALDO 110,N]FISTUAD MINOR, SUBDIVISION 0 N' FRA Ll, SITT PLAN Nl,aN39 Hinos i"Ill"z 31 Isol NVId 311S llVS3AO IS:)Il LOO MV 5 3H:)SVWNo9v NOISN31X3 NIVW 831VM V 1191HX3 I I �,� x 1-11 B I T" B: CATALDO HOMFISTEAD MINOR SUBDIVISION PRIN,"ATE, SANITARYLATFAM., A,1.1(,;NMF'.N'I' Nl,aN39 Hinos INIWNOIIV IVS3 , V i"Ill"z 311S 011 LOO NVIS 01 AHViINVS RVAINd NOISNRX3 H3M3S ANVIIN 's 9 1191HX3 3H:)SVWN o9v F"Xllllll']' Cl: CATALDO HOMESTEAD MINOR SUBDIVISION WATEIZ DESIGN PLANS a o ol o , ® Q w z CY LJ II � pp � L/a g F ® O U Q .�. 0 Q r_ z ® E. 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HOMESTEAD MINOR SU BDI VISION ENGINEER'S Ul"STIMATE- WA'Ff'll MAIN Engineering • Architecture • Land Surveying STAR 001, LLC PROPOSED C-STORE AND GAS STATION 3323 Prairie Avenue, South Bend, IN 46619 Engineer's Estimate of Probable Construction Costs - Water Main Construction 03/02/2020 (Revised 03/29/2020) Description Spec No Quantity Unit Unit Price Cost 1 Permits & Construction Engineering 1 LS 6.5% $7,650 2 Mobilization/Demobilization 1 LS 1.5% $1,520 3 Clearing/Grubbing & Erosion Control 1 LS $15,000.00 $15,000 4 Traffic Control 1 LS $7,500.00 $7,500 5 Water Main, 10" D.I. (Poly -Wrapped) 948 LFT $90.00 $85,320 6 Water Main, 10" D.I. (In Casing) 80 LFT $105.00 $8,400 7 Casing 24" (Bore and Jack) 80 LFT $1,000.00 $80,000 8 Water Service, 1-inch 1 EA $1,000.00 $1,000 9 Fire Hydrant Assembly 3 EA $4,500.00 $13,500 10 Gate Valve, 10" D.I. 3 EA $3,000.00 $9,000 11 10" Tapping Valve with Sleeve 1 EA $10,000.00 $10,000 12 Pavement Remove & Replace 100 SY $100.00 $10,000 13 Chain Link Fence Removal & Relocation 150 LFT $40.00 $6,000 14 Restoration, incl two (2) New Trees 1 LS $12,500.00 $12,500 Subtotal $267,390 Record Survey (As-Builts) 1 LS $5,000.00 $5,000 TOTAL: $272,390 0:\Projects\2017\17-0771 Burns Distributing Co\Permits & Plan Reviews\South Bend\Board of Public Works\Exhibit D\2020.03.04 - Engineer's Estimate\2020-03-29 Rev Star001 -Water Main Estimate m CATALDO MINOR SUBDIVISION PERFORINIIANCE SURE"I'Al BOND:WATER MAIN WEST FIND A Ml1lfV L INSURANCE COMIPAINY`m AGENCY INFORMATION: MCCARTHY INSURANCE GROUP, 13638 802 LINCOLNWAY WEST MISHAWAKA, IN 46544 OBLIGEE INFORMATION: City of South Bend 227 W Jefferson Blvd South Bend, IN 46601-1830 Transaction Description: New Business WB Index: 2433897 Bond Effective Date: 03/31 /2020 Bond Type: Subdivision Bond THE SILVER LINING* u BOND EXECUTION REPORT Date: 03/31 /2020 Bond Number:2433897 PRINCIPAL INFORMATION: Star 001, LLC 14612 Carrigan Ct Granger, IN 46530-4222 Work Description: Water Main Construction at 3325 Prairie Avenue (State Route 23), South Bend, Indiana 46614 Bond Penalty: $ 340,487.50 Premium: $ 7,310 THIS IS NOT AN INVOICE MICHIGAN ONLY: This policy is exempt from filing requirements of Section 2236 of the Insurance Code of 1956, 1956 PA 218 and MCL 500.2236. P.O. Box 620976 1 Middleton, WI 53562 1 ph (608) 410-3410 1 thesilverlining.com EST BE I D A MUTUAL INSURANCE COMPANY" KNOW ALL MEN BY THESE PRESENTS, that we Star 001, LLC 14612 Carrigan Ct, Granger, IN 46530-4222 Bond Number 2433897 Subdivision Bond Of as Principal, and WEST BEND MUTUAL INSURANCE COMPANY of Middleton, Wisconsin, a Wisconsin Cor- poration authorized to do business in the State of IN , as Surety, are held and firmly bound unto City of South Bend as Obligee, in the penal sum of Three Hundred and Forty Thousand Four Hundred and Eighty -Seven Dollars and Fifty Cents Dollars ($ 340,487.50 ), lawful money of the United States of America, for the payment of which well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, Star001, LLC has agreed to construct in Cataldo Homestead Minor Subdivision Subdivision, in South Bend, Indiana , the following improvements: Water Main Construction at 3325 Prairie Avenue (State Route 23), South Bend, Indiana 46614 NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if said Principal shall construct, or have constructed, the improvements herein described and shall save the Obligee harmless from any loss, cost or damage by reason of its failure to complete said work, then this obligation shall be null and void; otherwise to remain in full force and effect. Signed and Sealed this 31 day of March , 20 2020 Principal: Star 001, LLC By: (SEAL) Witness: Name Typed: , Title Surety: West Bend Mutual Insurance Company By: (SEAL) Witness: Name Typed: STACY VERVYNCKT , Attorney -In -Fact Title MICHIGAN ONLY: This policy is exempt from the filing requirements of Section 2236 of the Insurance Code of 1956, 1956 PA 218 and MCL 500.2236. NB 0008 11 17 PO Box 620976 1 Middleton, WI 53562 1 Phone: (608) 410-3410 1 Fax: (877) 674-2663 1 www.thesilverlining.com Page 1 of 1 1J1J'IEST END A MUTUAL INSURANCE COMPANY' POWER OF ATTORNEY THE SILVER LINING@ Bond No. 2433897 Know all men by these Presents, That West Bend Mutual Insurance Company, a corporation having its principal office in the City of West Bend, Wisconsin does make, constitute and appoint: STACY VERVYNCKT lawful Attorney(s)-in-fact, to make, execute, seal and deliver for and on its behalf as surety and as its act and deed any and all bonds, undertakings and contracts of suretyship, provided that no bond or undertaking or contract of suretyship executed under this authority shall exceed in amount the sum of: Ten Million Dollars ($10,000,000) This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of West Bend Mutual Insurance Company at a meeting duly called and held on the 21st day of December, 1999. Appointment of Attorney -In -Fact. The president or any vice president, or any other officer of West Bend Mutual Insurance Company may appoint by written certificate Attorneys -In -Fact to act on behalf of the company in the execution of and attesting of bonds and undertakings and other written obligatory instruments of like nature. The signature of any officer authorized hereby and the corporate seal may be affixed by facsimile to any such power of attorney or to any certificate relating therefore and any such power of attorney or certificate bearing such facsimile signatures or facsimile seal shall be valid and binding upon the company, and any such power so executed and certified by facsimile signatures and facsimile seal shall be valid and binding upon the company in the future with respect to any bond or undertaking or other writing obligatory in nature to which it is attached. Any such appointment may be revoked, for cause, or without cause, by any said officer at any time. In witness whereof, the West Bend Mutual Insurance Company has caused these presents to be signed by its president undersigned and its corporate seal to be hereto duly attested by its secretary this 22nd day of Se tember, 2017. Attest Christopher C. Z kart^oRPORAr, Secretary SEAL 7. ol State of Wisconsin County of Washington Kevin A. Steiner Chief Executive Officer/President On the 22nd day of September, 2017, before me personally came Kevin A. Steiner, to me known being by duly sworn, did depose and say that he resides in the County of Washington, State of Wisconsin; that he is the President of West Bend Mutual Insurance Company, the corporation described in and which executed the above instrument; that he knows the seal of the said corporation; that the seal affixed to said instrument is such corporate seal; that is was so affixed by order of the board of directors of said corporation and that he signed his name thereto by like order. c rAry `. Juli A. nedum Senior orporate Attorney Notary Public, Washington Co., WI My Commission is Permanent The undersigned, duly elected to the office stated below, now the incumbent in West Bend Mutual Insurance Company, a Wisconsin corporation authorized to make this certificate, Do Hereby Certify that the foregoing attached Power of Attorney remains in full force effect and has not been revoked and that the Resolution of the Board of Directors, set forth in the Power of Attorney is now in force. Signed and sealed at West Bend, Wisconsin this 31 st day of March 2020 7. Heather Dunn Vice President — Chief Financial Officer Notice: Any questions concerning this Power of Attorney may be directed to the Bond Manager at NSI, a division of West Bend Mutual Insurance Company. 1900 S. 181h Ave. West Bend, W1 53095 1 ph (262) 334-6430 1 1-800-236-5004 1 fax (262) 338-5058 1 www.thesilverlining.com CATALDO 110MEISTEAD MINOR SUBDIVISION I RE(.,lElPT0t�'S)"STEAl I)EVEI-,OPMF"'N'I'C'I-IAR(,I,"S AND (AFFEE v. 2018,10.12 K City of South Bend y Department of public Works Utility Verification Form Please submit Utility Verification fee of to» City of South Bend/Public Works Permit Office 227 W. Jefferson Blvd South Bend, IN 46601 Pursuant to the City of South Bend Municipal Code § 6-4.1 and 17-79 through 17-87, the Permit Manager's Office has verified available utilities and connection requirements. This form is for the express purposes of notifying an applicant of whether City utilities are available in a particular location and what requirements are necessary for connection. IT DOES NOT GUARANTEE CONNECTION TO CITY UTILITIES or CONSTITUTE A TAP PERMIT. The applicant must meet the requirements below prior to receiving tap permits to connect to City utilities: Property Owner's Name: Address/Lot #/Subdivision: City, State, ZIP: Star 001, LLC 3323 Prairie Avenue (S. R. 23) South Bend, IN ❑ Single -Family Residential M Inside City ❑ Outside City & 1 /8 Contiguous M Other ❑ Outside City & Not 1 /8 Contiguous The applicant is requesting the following connections: M Water No. of ERUs*: 7 Peak Factor: 4 IJ Sanitary Sewer * Equivalent Residential Unit (ERU) = 310 GPD Residential Peak Factor = 4 Cry Requirements iL Be Completed by the COX of South Beno: ® City Connection Fee $ 10,206.00 System Development Charge is billed by the City at the time the application for service is filed. 0 Wastewater Survey for Nonresidential Establishments (Note: May require industrial discharge permit and pre-treatment) 13 Waiver of Remonstration to Annexation Agreement • Annexation ❑ Requires System Improvements Public Works Authorized Signatur Date: By executing this Utility Verification Form, you hereby acknowledge the statements contained herein are true and accurate. If the City later determines that you misrepresented any statement on this Utility Verification Form, you will be charged the corrected City connection fee. You understand the requirements to connect to City utilities as set forth under South Bend City Ordinance and agree to meet the requirements set forth above. Property Owner or Representative Signature: Zmz_ 2=XIZ Date: _ glol-a Property Owner or Representative Phone: 120 - 6-05 *' Form Is not valid without Authorized Signature and Property Owner or Agent's Signature'* Check�f Check # Paid Date: UVF Fee Paid Date: Credit SDCS a Au 0 Cash a Cash City of South Bend Engineering Division/Permit Office 227 W. Jefferson Blvd., Suite 1316 South Bend, IN 46601 Receipt No. 1767 Date: 10/30/ 19 RECEIPT Payment Type Check/Ref # Amount Check 59731 $ 10,206.00 From: Burns Distributing Co., Inc. Project Address: 3323 Prairie Avenue (SR 23) For Project Name or Number: SDCs for Star 001, LLC - 3323 Prairie Ave (SR23) Comments: 1SDCs paid in full Payment received by: City of South Bend Engineering Division/Permit Office 227 W. Jefferson Blvd., Suite 1316 South Bend, IN 46601 Receipt No. 1768 Date: 10/30/ 19 RECEIPT Payment Type Check/Ref # Amount Check 59730 $ 50.00 From: Burns Distributing Co., Inc. Project Address: 3323 Prairie Avenue (SR 23) For Project Name or Number: UVF for Star 001, LLC - 3323 Prairie Ave (SR23) Comments: J UVF paid in full Payment received by: CATALDO HOMESTEAD MINOR SUBDIVISION i CERTIFICATE OFANSUNANCE" / A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 04/01 /2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: McCarthy Insurance Group (574) 259-5622 a/c, (574) 256-7822 A/CNNo Ext : No): P.O. Box 1377 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 802 Lincolnway West INSURERA: Auto Owers Mishawaka IN 46544 INSURED INSURER B Star 001 LLC INSURER C : INSURER D : 3323 Prairie Avenue INSURER E : South Bend IN 46614 INSURER F : COVERAGES CERTIFICATE NUMBER: 2020-2021 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE FX OCCUR PREM SDA AGES Ea oNcurDrence $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL&ADV INJURY $ A 5278110400 03/31/2020 03/21/2021 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ PRO ❑ LOC JECT PRODUCTS-COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accide nt) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 A EXCESS LAB CLAIMS -MADE 5278131200 03/31/2020 03/31/2021 DED I I RETENTION $ $ P` WORKERS COMPENSATION AND EMPLOYERS' LIABI LI TY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A 09307597 03/31/2020 03/31/2021 X STATUTE EORH E.L. EACH ACCIDENT SOO,000 $ E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 500,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of South Bend named as additional insured on the general liability per the terms and conditions of the policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of South Bend ACCORDANCE WITH THE POLICY PROVISIONS. 227 W Jefferson Blvd AUTHORIZED REPRESENTATIVE South Bend IN 46601 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 4/6/2020 Department Engineering Name Sue Ellen Doudrick Phone Extension BPW Date 4/14/2020 Phone Extension - Review and Approval Required Prior to Submittal to Board Diversity Compliance ❑ Officer Name and Inclusion Officer BPW Attorney ® Attorney Name Clara McDaniels Dept. Attorney ❑ Attorney Name Purchasing ❑ Check the Abbrobriate Item TvDe — U Professional Services Agreement U Contract ❑ Open Market Contract ❑ Amendment/Addendum ❑ Bid Opening ❑ Bid Award ❑ Quote Opening ❑ Quote Award ❑ Proposal Opening ❑ C/O & PCA No. ❑ Chg. Order, No. ❑ Traffic Control ® Other: Water Service Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description Amount of Previous Amount Information Star 001, LLC All Submissions U Proposal ❑ Special Purchase, QPA ❑ Req. to Advertise ❑ Title Sheet ❑ Reject Bids/Quotes ❑ Resolution ❑ Ease./Encroach ❑ Ease./Encroach ❑ Yes ❑ If Yes, Approved by Purchasing ❑ No ❑ WBE Completed E-Verify Form Attached ❑ Yes No Water Service Agreement for Star 001. LLC DP 18-025 N/a n/a n/a See attached leizal agreement. Water Service Agreement for Star 001, LLC to construct a water main from Four Winds Casino to Star 001 property under Prairie Avenue to serve the Star 001 property. The water main will become a public water main once the terms of the agreement are met. For Change Orders Only ❑ Increase ❑ Decrease Current Percent of Change: New Amount Increase % Decrease ( % Increase % Total Percent of Change: Decrease Time Extension Amount: