Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Award Bid - 2020 Curb & Sidewalk Construction Proj No. 120-001 - Premium Concrete Services, Inc.
1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND, INDIANA 46601-1830 CITY OF SOUTH BEND JAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS May 26, 2020 Mr. Robert Jones Premium Concrete Services, Inc. 712 Richmond St. Elkhart, IN 46516 ±.eL eI(fj'> remiLinicoticl:et:eotilitIe.com PHONE 574/235-9251 FAx 574/ 235-9171 RE: Award Bid — 2020 Curb & Sidewalk Construction — Project No. 120-001 Dear Mr. Jones: The Board of Public Works, at its meeting held on May 26, 2020, awarded the above referenced project to you in an amount, not to exceed $202,213 Divisions B1, B2, B3, Cl, and D1. Please forward the following documents in one submittal blAune 9 2020 to my attention for Board of Public Works approval to 1lieHs1 '(>)sotal�ibetidi��L cv: 1) One (1) signed original of the Public Works Contract (enclosed) 2) Labor & Material Payment Bond 3) Performance Bond (125% of Bid Amount) 4) Certificate of Insurance naming the City of South Bend as an additional insured 5) Item 44 for all subcontractors you use If you have any further questions regarding this matter, please call this office at (574) 235-9251. Sincerely, s/Linda M. Martin, Clerk Enclosures GARY A. GILOT ELIZABETH A. MARADIK THERESE J. DORAU JORDAN V. GATHERS JOSEPH R. MOLNAR BOARD OF PUBLIC WORKS CITY OF SOUTH BEND, INDIANA PUBLIC WORKS CONTRACT THIS AGREEMENT, made and entered into this 26th Day of May, 2020, by and between, Premium Concrete Services, Inc., 712 Richmond St., Elkhart, IN 46516, HEREINAFTER called the Contractor, and the Board of Public Works herein called the 'Board". WITNESSETH: That the Contractor covenants and agrees to make the following improvement, as fully set out in the Request for Quotations, Standard Specifications, Special Provisions, Plans, and Bid Proposals, all of which are set forth as a part of this Contract, for: PROJECT NO. DESCRIPTION: COMPLETION DATE 1 7.0-001 2020 CURB & SIDEWALK CONSTRUCTION SEE SPECIFICATIONS AMOUNT: NTE $202,213 Divisions B1, B2, B3, C1, and D1 FUNDING: MVH The unit prices for this improvement were those prices as received and accepted by the Board on the 12th Day of May, 2020. The Contractor further agrees to notify the Engineer when this improvement is completed. This notification shall be in the form of a Completion Affidavit, signed by the Contractor. Upon final acceptance of the improvement by the Engineer, the Contractors final estimate will be presented to the Board for final Payment with one (1) copy of the Completion Affidavit and one (1) copy of a Waiver of Lien. 130ARD OF PLJ13LIC WORKS PREMIUM CONCRETE C� SERVICES, INC. Gary A. Gilot, President Elizabeth A. Maradik, Member Joseph R. Molnar, Member Therese J. Doran, Member Printed Name Jordan V. Gathers, Member Signature ATTEST: Linda M. Martin, Clerk CERTIFICATION (To be completed if Contractor is a Corporation) I, , certify that I am Secretary of the Corporation named as Contractor herein; that who signed this Agreement on behalf of the Contractor was then of said Corporation; that said agreement was duly signed for and in behalf of said Corporation by authority of its governing body, and is within the scope of its corporate powers. Secretary Corporate Seal • 0 9 i i Project Name 2020 Curb and Sidewalk Construction Project No. 120-001 IFor Bids Due May 12, 2020 at 9:30am Local Time PART (Must be completed for all bids. Please type or print) Date: 6119 lro Bidder (Firm): YA4Fmxx,,7 e-7A k, Address: City/State/Zip: m -TA).. _ 64 Telephone Number: 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: 62c`j e> Lux-5_rraJ e-K 66P5-i`A&wr- ° A.) the City of South Bend, Indiana, in accordance with plans and specifications prepared by: P A4AT--7AW-7— ®r- ?U6C_ &,)e>AV_5 0rvX_s A) CIA 'A.)GrA)C- and dated for the sum of (enter the Total Bid as shown on the Proposal) F t� Nwwv ooF. ooumw Foy auomeo "7o . (s Yo f , - ) (Enter sum of Total Bid shown on Proposal) ,01.A5, (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. 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 City of South Bend. If the bid is to be awarded on a unit basis, the itemization of the units shall be shown on a separate attachment. By ADZ� (Signature) (Printed Name of Person Signing) The above bid is accepted this Subject to the following conditions: 130.ARD OF PUBLIC. WORKS Gary A. Gdot, President n' �_ _4� Y - Elizabeth 1 Mamdik, Member JosephR. Molnar, Member lberese J. Dolan, Mend - Jordan V. Gathers, Member A TEST: 2incfa 0411111r LindaM. Martin, Clerk ACCEPTANCE day of Version 01/29/2020 Contractor's Bid for Public Works - 2 2© � INTER -OFFICE MEMORANDUM DEPARTMENT OF PUBLIC WORKS DIVISION OF ENGINEERING TO: Linda M. Martin, Clerk Board of Public Works FROM: Alicia Czarnecki, Project Engineer SUBJECT: Award Project No. 120-001 2020 Curb and Sidewalk Construction DATE: May 20, 2020 On May 12, 2020, the Board of Public Works opened and read bids for the above project, which consisted of several divisions. The bidders ranked as follows: Division Al Bidder Bid Amount 1. Rieth-Riley Construction Co., Inc. $77,587.00 2. Premium Concrete Services, Inc. $96,106.00 3. Walsh & Kelly, Inc. $79,299.00 4. Ziolkowski Construction, Inc. $79,243.00 Division A2 Bidder Bid Amount 1. Rieth-Riley Construction Co., Inc. $52,888.00 2. Premium Concrete Services, Inc. $63,454.00 3. Walsh & Kelly, Inc. $63,840.00 4. Ziolkowski Construction, Inc. $67,684.00 Division 131 Bidder Bid Amount 1. Premium Concrete Services, Inc. $66,534.50 2. Rieth-Riley Construction Co., Inc. $76,311.00 3. Walsh & Kelly, Inc. $82,611.00 4. Ziolkowski Construction, Inc. $88,436.00 Division 132 Bidder Bid Amount 1. Premium Concrete Services, Inc. $23,080.00 2. Rieth-Riley Construction Co., Inc. $25,905.00 3. Walsh & Kelly, Inc. $24,490.00 4. Ziolkowski Construction, Inc. $28,674.00 Page 1 of 2 Division 133 Bidder Bid Amount 1. Premium Concrete Services, Inc. $32,728.00 2. Rieth-Riley Construction Co., Inc. $36,566.00 3. Walsh & Kelly, Inc. $35,608.00 4. Ziolkowski Construction, Inc. $40,346.00 Division C1 Bidder Bid Amount 1. Premium Concrete Services, Inc. $35,971.50 2. Rieth-Riley Construction Co., Inc. $38,970.00 3. Walsh & Kelly, Inc. $38,722.00 4. Ziolkowski Construction, Inc. $43,891.00 Division D1 Bidder Bid Amount 1. Premium Concrete Services, Inc. $43,899.00 2. Rieth-Riley Construction Co., Inc. $46,291.00 3. Walsh & Kelly, Inc. $51,456.00 4. Ziolkowski Construction, Inc. $57,149.00 Division D2 Bidder Bid Amount 1. Rieth-Riley Construction Co., Inc. $37,532.00 2. Premium Concrete Services, Inc. $39,653.00 3. Walsh & Kelly, Inc. $43,480.00 4. Ziolkowski Construction, Inc. $48,890.00 I recommend award of a contract for Divisions Al, A2, and D2 to the lowest responsive / responsible bidder, Rieth-Riley Construction Co., Inc. in the amount of $168,007.00. I recommend award of a contract for Divisions B1, B2, B3, C1, and D1 to the lowest responsive / responsible bidder, Premium Concrete Services, Inc. in the amount of $202,213.00. Sufficient funds have been has appropriated from MVH, 202-06-602-505-431000. Please call with your questions. Enc. Bid Tabulation Page 2 of 2 0 0 �p� 0 0 vo 0 0 rod 0 0 v U N y H3 H3 H3 H3 H3 H3 H3 W C O U O O o 0 O O 0 0 O O 0 0 O 0 3 a` 0 Y C O � N - - - - - - - m 0 0 0 0 o0 D7 D7 0 0 0 0 0o V D7 0 0 0 0 uiov V V 0 0 0 0 of N N m T N Y oC H3 H3 H3 H3 H3 H3 H3 W O O o 0 O O 0 0 O O 0 0 O 0 L y °i A vvri co rco ri U y o N O O rip V D7 O O cpom m r O O V N O O o V U F M (O E m m y — N N �- N H3 H3 �M - M H3 H3 H3 H3 O! H3 fA O O N r O O N M O O D7 N O N U O V E a 'E c m � O N U o C F 0 0 0 0 C1 C1 00 M V 0 0 0 0 C1 1S) orn (O m 0 0 0 0 O O u�u�rn O V 0 0 0 0 N 1� m V7 O E � N M NN � N NN � N M n n CU Hf E9 E9 E9 E9 E9 E9 iR o 0 0 0 0 0 0 O c N U W V O (O (O W V a` +' C ua ua ua ua ua ua ua m O 0 0 0 0 o0 o�p O N 0 0 0 0 0o �p �p r D7 0 0 0 0 ui uio rho M 0 0 0 0 pi r c N E d N w Y EA EH EH EH EH EH EH � N •y N c a` w .0 O O O O EH EH O O O O EH EH O O O O EH EH O O EH �j O O O O 0 o O O O O m o O O O O cp O O O O cp cp O O O O v o O O O O cp ao c Fo- mm om rm cprnm v_r m O E U N N M C O U ------------ OO o 0 O O 0 0 O O 0 0 O O 0 0 O O 0 0 O 0 y V V (O V V M (O N (O N M 3 1 W (O V V N Y C O � A O O 0 0 o 0 V N O O 0 0 0 0 O N O O 0 0 0 0 r N O O 0 0 0 0 O N O O 0 0 0 0 O N O o 0 0 o pi M OD T N Y ------------ O O ........ O O O O O o 0 0 o .. 0 oC L y m N Div uir 000ui uio �- U C A y O O O O O O oo O O O O O O No O O O O O O NN O O O O O O �cpm O O O O O N rr O O O O N� u� U r 'LO w N M M Z E m � N U C O U U O O �O . (O (O O O O O O O O O D7 O N O O O O O O O O O O O r r O O N E a A v N E c m � O N U D 0 0 0 0 O O O O 0 0 0 0 O O C' -I 0 0 0 0 N O N LO 0 0 0 0 O O O O 0 0 0 0 O w O 0 0 0 0 O GD GD N O LO (0 O cN r N) a OD U y ------------ o 0 O O 0 0 O O 0 0 O) O 0 0 O O 0 0 O O 0 O O c U C a = u� co u� N co N = D: ua ua ua ua ua ua ua ua ua ua ua m O O O O o 0 O O O O O O 0 0 O O O O O O 0 0 O O O O O O 0 0 O O O O O O 0 0 O N O O O o o pi O N N E E d N ------------ N t0 N •y N c a` O O O O O O O O �O �O O O O O �O O O O O O O O O O O O .0 EH EH EH EH EH EH EH EH EH EH EH �j C A O O O O O �O N V O O O O O O V O O O O O O O M N O O O O O O (O O O O O M N N N O O O O O t0 O M C F o E U N N D7 rNrnm.-.-ui � N V V N N .- V D7 vrn� V V C O U O o 0 O O O 0 0 O O 0 0 O O 0 0 O O 0 0 O 0 3 1 O N V N Y C O � A O O 0 0 o 0 O O 0 0 0 o O O 0 0 v r O O 0 0 o 0 O O 0 0 0 0 O o 0 0 0 O D7 O �O r N N N N (O M O t0 N N c E N T NN ao Y O O O O O O O O O O O O O O O O O O O O O O oC L y d N V V O N D7 O O O� O 1 'c N N N U C m O O �O O r o O O O O 0 o O O O O rn o O O O O 0 0 O O O O o ro O O O V7 o a NN N — ------------ N U O V O O M N O O O M O O M O O O r O O O O M O N N E LL N .E c m � IL O N� U o 0 0 O O cp �� 0 0 O O rn�pc 0 0 O O 0 0 O O NCO 0 0 O O oom 0 0 O o O E U N �- M N n yU H3 H3 H3 H3 H3 H3 H3 H3 H3 H3 H3 W C C O— OO O O O O O O O O O U o 00 �poo 00 000 O:. m O O O O O o uio N M O O O O oui N (O O O O O ui r O O O O o0 O D7 O O O O 00o M O O O o N O O N m E.-M E d N ------------ ao N •y N C V c a` w O O O O O . O O O O . . O O O O . . O O O O . O O O O O O . O O O .0 EH EH EH EH EH EH EH EH EH EH EH Jj C N O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O V V C F O N V O (p N (p N N N t0 U N o O U O 0 o O O O 0 0 O O 0 0 O O 0 0 O O 0 0 y U V cp V V �O V V cp O 3 1 O N N V Y C O � A O O 0 0 o 0 O O 0 0 0 0 O O 0 0 0 0 O O 0 0 0 0 O O O 0 0 0 0 o pi U E�- c E T N N Y O O O O O O O O O O O O O O O O o 0 O o oC L y m Nri vo mrco 0o ui �- 1 .0 EH EH EH EH EH EH EH EH EH EH U C N.. O O O O O O O O O O.. O O O O O O O O 0 0 O O O O O O 0 O O N N N N — N O O O O O O O O O O U E E m � a` uauuuuuuuuu - O m U o O O O O o 0 NN O O O O 0 o. Apo O O O O o ocpc O O O O o 0 �p O O O O O O 0 o ui �p Apo U N N C U O C O O O O O O O O O O U oo Apo .00 00 0 MN t N = m O O O O o0 O O O O 00 O O O O 00o O O O O uio O O O O O o oui E � Y N N W N •y - - - - - - - - - - H O O O O O O O O O O O O O O O O O O O O N � a` W .c �j C N O O O O 0 0 O O O O 0 0 O O O O 0 0 O O O O 0. O O O O O O O O. C F V D7 (O N V D7 r r M U N C O U O O o 0 O O 0 0 O O 0 0 O O 0 0 O O 0 0 y d y V V O V (p V O V D7 O O D7 O �p O Y C O � A O O O O o 0 O O O O 0 0 O O O O 0 0 O O O O 0 o O O o O O O m o ao c E T N M Y O O O O O O O O O O O O O O O O o 0 O O oC L .0 EH EH EH EH EH EH EH EH EH EH U C N N YO U F O O O O C1 C1 S O O N O O O O C1 C1 N r O) M O O O O C1 N N �O �p OJ O O O O O O O O OJ N O O O O O O f0 O OD r v N r 0 n NN N — N U O V O O O N O O OJ �p O O O) N O O O O O O OJ O ro co u� E LL` m � O m U o O O o0000000coo. o�pNoc�p O O O O O O Apo O O O rncpm C N (p N (p V O (p r N N U N M C U O C OO O O O O O O O O U O Apo OO o0O o0 � U N t N = m o O O O O 00000ui0000ui o�p O O O O �p O O O O omrm�p O O O O O o 0 O O o cp u� � E d N W Y - - - - - - - - - - H N •y N C U W O O O O O 6 O O O O 6 6 O O O O 6. O O O 9.9 O O.. O O .c K) K) K) K) K) K) K) K) K) K) �j C N O O O O O O O O O O O O O O V O O O O O O O O O O O O O O O M N O O O O O M N O O O O O N V O O O O O O (p O! U N C O U O O o 0 O O 0 0 O0 O 0 O O 0 0 O O 0 0 O O 0 0 O 0 3 1 O N N V V N Y C O � A � O O O O O O 0 0 N M O O O O O O V O N O O O O O O O (p N �- D7 O O O O O O D7 O �- (p O O O O O O O O N M O O O o O N (p S O o 0 0 O N O N c E T N M Y -------------- O O O O O O O O O O O O O O O O O O O O O O O O O O oC L 1 .0 N N U C m O O O O o 0 O O O O 0 0 O O O O- 0 o O O O r v O O O O o 0 O O O O 0 0 O O O N 0 ' N N N — -------------- N U C O U O O O O) O O OJ N O O d' OJ O O f0 N O O C1 C1 O O Cl In O U OJ O M �p E IL. M .E E m � . O A U o 0 0 O O O O 00 0 0 O O O O 00 0 0 O O O O ovcp 0 0 O O O O o�p 0 0 O O O O oocp 0 0 O O O N 0 0 O o N O �p n U N M -------------- C U O C O O O O O O O O O O O O O U o 0 0 0 0 0 0 0 0 0 0 0 0 t N = m O O O O o 0 O O O O 0 0 O O O O 0 o. O O O O o O O O O 0 0 O O O O 0 0 O O O o o N E E N W Y ---EH --------- H N •y N C V � a W O O O O O . O O O O . . O O O O . . O O O O . . mrn O O O O 0 0 Apr O O O O 0. O O O N .c K) K) K) K) K) K) K) K) K) K) K) K) K) Jj O O O O O N N O O O O O O O O O O D7 W� O O O O V O O O O O O N N c D7 V D7 O V M N V U N C O U O o O 0 O O 0 0 O O 0 0 O O 0 0 O O 0 0 Y °' y V voivomoriorir V (O V V N V M N M 0 Y C O � O O 0 0 O O 0 0 O O 0 0 O O 0 0 O O o 0 0 0 � E T N � Y O O o 0 O O 0 0 O O 0 0 O o 0 0 0 0 0 0 oC L y m ri ri ri of rcovooui �- 1 'c ti C N D o 0 O O O d' 0 0 O O O N N 0 0 O O f0 I 0 0 O O O 0 0 0 O O O N U F A N f0 N r 0 d' N r OD q .Z E m m N - N U C O U O O O O O O O O O O O O O O O O O O O O E a E N = - O A O O O O 0 0. O O O O O.. O O O O O O O O 0 0 o 0 0 O O o 0. � O U N V NH3 H3 H3 H3 H3 H3 H3 H3 H3 H3 W C U O C O O O O O O O O O O U o� o 0 0 0 0 0 0 0 t N = O O O O O O O N O O O O N N O O O O M O O O O O O O O O O O O O �O t0 N ~ r M �O V N M r t0 E E d N w Y - - - - - - - - - - H N •y N C a` w O O O O O O O O O O O O O O O O O O O O .c K) K) K) K) K) K) K) K) K) K) �j O O O O O O O O O O O O O O O O O O O O O O O O U N ------------ C O U y V O O o 0 V (O O O 0 0 V V O O 0 0 N V O O 0 0 M (O O O 0 0 (O N O 0 (O Y C O � A ........ 0 0 O O 0 0 O O 0 0 N N 0 0 O 0 o .. 0 0 0 0 0 0 0 0 0 � E N T � Y oC ------------ o 0 0 0 0 0 0 0 0 0 0 L ............. yNriv m m r�i o0o ui �- � a N U C A N O O O O 0 0 O O O O 0 0 O O O O (O N O O O O . V O O O O O O O O O O O M T ---------- N U C O U� O O O O N O O O O N O O O O O D7 r O O O O r N O O O O O O O O O E a m r N � E � m � O N. U O C 0 0 0 0 O. o: 0 0 0 0 O o: N 0 0 0 0 . . f0 N 0 0 0 0 0 0 f0 0 0 0 0 0 0 f0 �O 0 0 0 0 0 fV r V7 O E MOJM OJ �MNN N1� M ------------ O O O O O O O O O O O O C U u�oo our u�o 000 0 C a _ o � co u� N co � C ua ua ua ua ua ua ua ua ua ua ua {p O O O O O O O.. O N O O O O M O O O O O O. r M O O O O 0 N (O O O O O 0 0 O O O O O N m r N 'O M 10 E E d N N •y N C a` W .c O O O O K) K) O O O O K) K) O O O O K) K) O O O O K) K) O O O O N K) K) O O K) Project Name o20 25 e,,,A, j A ijio -5xPrEW Lk Project No. /20 — 00 For Bids Due InAy I �� Contractor Name: 10- , The City seeks to enhance its ability to identify responsive and responsible bidders on all City public works projects by institution of comprehensive submission requirements in compliance with State law. Quality workmanship, efficient operation, safety, and timely completion of projects requires that all bidders meet certain minimum requirements to be responsive and responsible bidders. THIS FORM MUST BE SUBMITTED WITH YOUR BID. INSTRUCTIONS: If you are a pre -qualified bidder, complete Section I only. If you are not a pre -qualified bidder, complete Section II only. Section 11 acts as an application for pre -qualification. Submission of Section 11 will allow the bidder to be considered for pre -qualification for bids with the City of South Bend Department of Public Works. Pre - qualified bidders will then be exempt from a portion of the submission requirements outlined in Section 6- 63 of The Responsible Bidding Ordinance No. 10594-18 (hereinafter, "Responsible Bidding Ordinance") for a period of twelve (12) months. Thereafter, contractors who are pre -qualified must submit a complete application for continuation of "pre - qualified" standing, on a form provided by the City ("Responsible Bidder Checklist (1) Pre -Qualified Bidders") by December 315l for the upcoming calendar year, or within twelve (12) months of obtaining pre - qualified standing. If the status of any item changes within the twelve (12) months, it is the responsibility of the contractor to notify the City. Failure by any pre -qualified contractor to submit its complete application for continuation of "pre -qualified" standing within the time prescribed above shall result in automatic removal of the designation, effective January 1 of the following year, or immediately following the twelve (12) months of pre -qualified standing. However, the "removed" contractor or subcontractor shall still be permitted to bid on City public works projects, though the contractor must submit all required documents under 6-63 until "pre -qualified" status is re-established. Please Note: The City reserves the right to request supplemental information from the bidder, additional verification of any information provided by the bidder, and may also conduct random inquiries of the bidder's current and previous customers regardless of pre -qualified standing. It is the sole responsibility of the potential bidder to comply with all submission requirements applicable to the bidder in Section 6-63 of the Responsible Bidding Ordinance no later than the date of the public bid opening. PRE -QUALIFIED BIDDER CHECKLIST (a) Acknowledgements: (i)_ By checking this box, I hereby acknowledge that I am a pre -qualified bidder with the City of South Bend and that I have met the pre -qualification requirements within the last twelve (12) months. A copy of my Pre -Qualification verification letter is attached. (ii) By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided by me, and may also conduct random inquiries of my current and prior customers. (b) Attachments: {i) Indiana Secretary of State's on-line records (ie. Business verification) dated within sixty (60) days of the submission of said document showing that business is in existence, current with the Indiana Secretary of State's Business Entity Report, and eligible for a certificate of good standing. (Not applicable to individuals, sole proprietors or partnerships). (ii) Statement on staffing capabilities, including labor sources. This statement indicates and ensures I have sufficient employees on staff to complete the work. It outlines how I intend to meet the staffing needs of the work. (iii) List of projects of similar size and scope of work performed in all areas, including the State of Indiana, within the last three (3) years. (iv) For every project, submit evidence of participation in apprenticeship and training programs, applicable to the work to be performed on the project, which are approved by and registered with the United States Department of Labor's Office of Apprenticeship, or its successor organization. BID/PROPOSAL CITY OF SOUTH BEND Project Name: 2020 Curb and Sidewalk Construction Project Number: 120-001 For Bids Due: May 12, 2020 at 9:30am Local Time — see https:lisouthbendin.gov/bids for electronic bid submission information Contractor Name: PA E 01 rat 01 cf6,N TE 5 kX0, DIVISION Al Item No. Description Quantity Unit Unit Price Total Amount 1 CONCRETE SIDEWALK, REMOVE 350 SYS 7.- 2 CONCRETE SIDEWALK, 4-IN 350 SYS 3 CONCRETE CURB, REMOVE 630 LFT 4 CONCRETE CURB, MODIFIED 630 LFT o 5 CONCRETE APPROACH, REMOVE 25 SYS 6 PCCP FOR APPROACHES, 6-IN 25 SYS 2- 7 TOPSOIL AND SEEDING 28 SYS ®& DIVISION Al TOTAL DIVISION A2 Item No. Description Quantity Unit Unit Price Total Amount 1 CONCRETE SIDEWALK, REMOVE 200 SYS 169 2 CONCRETE SIDEWALK, 4-IN 200 SYS <10 3 CONCRETE CURB, REMOVE 320 LFT 2 1 e 4 CONCRETE CURB, MODIFIED 320 LFT 5� 9' 7 TOPSOIL AND SEEDING 180 SYS ,2aea 11 TREE, REMOVE, 30 IN 1 EA a?— 12 TREE, REMOVE, 48 IN 1 EA 13 STUMP, REMOVE 2 EARao 14 PLANT, DECIDUOUS TREE, SINGLE STEM, 2- IN TO 2.5 IN 4 EA 7,1® 15 CURB RAMP, REMOVE 1 16 1 SYS C)? 17 PAIRED PERPENDICULAR CURB RAMP 1 16 1 SYS q j. e> i DIVISION A2 TOTAL DIVISION B1 Item No. Description Quantity Unit Unit Price Total Amount 1 CONCRETE SIDEWALK, REMOVE 405 SYS �2 2 CONCRETE SIDEWALK, 4-IN 405 SYS ®/® 3 CONCRETE CURB, REMOVE 210 LFT Z0 e� 4 CONCRETE CURB, MODIFIED 210 LFT ! 5 CONCRETE APPROACH, REMOVE 13 SYS 6 PCCP FOR APPROACHES, 6-IN 13 SYS b 7 TOPSOIL AND SEEDING 120 SYS 6 11 TREE, REMOVE, 30 IN 1 EA 13 STUMP, REMOVE 1 EA 15 CURB RAMP, REMOVE 56 SYS Z 17 PAIRED PERPENDICULAR CURB RAMP 40 SYS -22 ®®/o DIVISION B1 TOTAL (®(�"- Version 01/29/2020 Contractor's Bid for Public Works - 7 BID/PROPOSAL��E: CITY OF SOUTH BEND Project Name: 2020 Curb and Sidewalk Construction Project Number: 120-001 For Bids Due: May 12, 2020 at 9:30am Local Time — see https://southbendin.gov/bids for electronic bid submission information Contractor Name: AEAgruo? enDA)C- RY- DIVISION B2 Item No. Description Quantity Unit Unit Price Total Amount 1 CONCRETE SIDEWALK, REMOVE 70 SYS A' 2-irige- 2 CONCRETE SIDEWALK, 4-IN 70 SYS � 3 CONCRETE CURB, REMOVE 100 LIFT / .� 4 CONCRETE CURB, MODIFIED 100 LFT 5,Z 5 CONCRETE APPROACH, REMOVE 30 SYS 6 PCCP FOR APPROACHES, 6-IN 30 SYS ®�{ 7 TOPSOIL AND SEEDING 60 SYS J " yo jae- 10 TREE, REMOVE, 18 IN 1 EA ® 40 0 11 TREE, REMOVE, 30 IN 1 EA 4A80 p ,0 14 PLANT, DECIDUOUS TREE, SINGLE STEM, 2- IN TO 2.5 IN 2 EA DIVISION B3 Item No. Description Quantity Unit Unit Price Total Amount 1 CONCRETE SIDEWALK, REMOVE 100 SYS e� 3, ® 0 2 CONCRETE SIDEWALK, 4-IN 100 SYS &1Z ($00 3 CONCRETE CURB, REMOVE 140 LFT 3. 9,70-!2E� 4 CONCRETE CURB, MODIFIED 140 LFT 61 P 70 7 TOPSOIL AND SEEDING 80 SYS It 5'170 10 TREE, REMOVE, 18 IN 1 EA s2 11 TREE, REMOVE, 30 IN 3 EA 0 ea - soc, 14 PLANT, DECIDUOUS TREE, SINGLE STEM, 2- IN TO2.5IN 4 EA CPO 15 CURB RAMP, REMOVE 16 SYS 7� 16 ONE-WAY PERPENDICULAR CURB RAMP 16 SYS DIVISION B3 TOTAL DIVISION C1 Item No. Description Quantity Unit Unit Price Total Amount 1 CONCRETE SIDEWALK, REMOVE 100 SYS 07-- 9 �- 2 CONCRETE SIDEWALK, 4-IN 100 SYS -7/ ate' 3 CONCRETE CURB, REMOVE 160 LFT 4 CONCRETE CURB, MODIFIED 160 LFT - % 5 CONCRETE APPROACH, REMOVE 20 SYS 6 PCCP FOR APPROACHES, 6-IN 20 SYS 7 TOPSOIL AND SEEDING 35 SYS 7 10 TREE, REMOVE, 18 IN 2 EA -1 11 TREE, REMOVE, 30 IN 1 EA 13 STUMP, REMOVE 1 EA 14 PLANT, DECIDUOUS TREE, SINGLE STEM, 2- IN TO 2.5 IN 4 EA 5y® 15 CURB RAMP, REMOVE 16 SYS q -0- 17 PAIRED PERPENDICULAR CURB RAMP 16 SYS DIVISION C1 TOTAL' 3 5 21 Version 01/29/2020 Contractor's Bid for Public Works - 8 BID/PROPOSAL CITY OF SOUTH BEND Project Name: 2020 Curb and Sidewalk Construction Project Number: 120-001 For Bids Due: May 12, 2020 at 9:30am Local Time — see https:/isouthbendin.gov/bids for electronic bid submission information Contractor Name: )CRZ T Item No. Description Quantity Unit Unit Price Total Amount 1 CONCRETE SIDEWALK, REMOVE 180 SYS- 2 CONCRETE SIDEWALK, 4-IN 180 SYS is - /Ago ea- 3 CONCRETE CURB, REMOVE 225 LFT -!!—e 3, ev �o— 4 CONCRETE CURB, MODIFIED 225 LFT 5 CONCRETE APPROACH, REMOVE 17 SYS' 6 PCCP FOR APPROACHES, 6-IN 17 SYS 1AA 7 7 TOPSOIL AND SEEDING 125 SYS ,- I If 11 TREE, REMOVE, 30 IN 4 EA 00 13 STUMP, REMOVE 1 EA p 14 PLANT, DECIDUOUS TREE, SINGLE STEM, 2- IN TO 2.5 IN 5 EA 5�� DIVISION WdTOTAL ®�g DIVISION D2 D I - Item No. Description Quantity Unit Unit Price Total Amount 1 CONCRETE SIDEWALK, REMOVE 150 SYS 2 CONCRETE. SIDEWALK, 4-IN 150 SYS 3 CONCRETE CURB, REMOVE 205 LFT g® gza- 4 CONCRETE CURB, MODIFIED 205 LFT 0 "® A 5-c-' 5 CONCRETE APPROACH, REMOVE 14 SYS .2-2 6 PCCP FOR APPROACHES, 6-IN 14 SYS 7 TOPSOIL AND SEEDING 115 SYS 10 TREE, REMOVE, 18 IN 2 EA 12 TREE, REMOVE, 48 IN 1 EA ! E--�' 13 STUMP, REMOVE 1 EA 14 PLANT, DECIDUOUS TREE, SINGLE STEM, 2- IN TO 2.5 IN 4 EA.02 5-;� �® DIVISION kdTOTAL 3 gf �-53 Bidder (Firm): PA M-rC4,,n COAXAF--fir' C- Address: -2 /ZX.C,& ,vAh® S-7— City/State/Zip: t4 I AJ � 5�/� Telephone Number: By (Signature) (Printed Name of Person Signing) Version 01/29/2020 Contractor's Sid for Public Works - 9 CITY OF SOUTH BEND I !-1 MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MWBE-1.0 MWBE UTILIZATION PLAN This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MWBE participation. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the MWBE qualifications. Project Number: 120-001 Project Name: 2020 Curb and Sidewalk Construction Bidder: ?44pilmAq e 72-c Total Bid Amount: y � MWBE Goal: Page of Name &Address of MWBE Primary Contact Person (NamelTelephone) Scope of Work to be Per€amed (Attach scope/schedule if you need additional space) Dol[arAmount of MWBE Camponenl rcentage of Total �1,"ro osa[ 71 p�yp�� E'L9MAA,r, siv V6 r®& 33gie) Submitted by: 64,1 16C 5 -Aov� , Print Name Signat re Version 01/29/202G Contractor's Hid for Public Works - 10 -)r- /)`�? Date L; CITY OF SOUTH BEND4^ci:, MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MWBE-2.0 N;l EVIDENCE OF GOOD FAITH EFFORTS This completed form should be included as part of the Bids documents related to City of South Bend Public Works Projects requiring Good Faith Efforts to obtain MBEIWBE participation. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business as defined by the Indiana Department of Administration (1130A"), Project Number: 120-001 Date: 5' / IA l 12-6 Project Name: 2020 Curb and Sidewalk Construction Bidder: PA&size C�PA)E F_ 5 1QU a—'-s Contact Person: ,-)( ) 1&A g y Telephone: 7.7G ~,019 Address: ? 12, f5°/— City: 9 G1/-14-40.-r- State: Zip: C1657 Email: A,4K&' &CA1E'UM C0AJP_rE 6 AILZAI& Cool To determine whether a bidder has demonstrated good faith efforts to reach the MBEMBE utilization goals set forth in the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or commissions, REQUIRE ALL of the foliowing Good Faith Efforts as listed in the table below*: f EVIDENCE OF GOOD FAITH EFFORTS MBEIWBE LIST(S): The bidder reviewed the City of South Bend's Minority and Women Business -,/ Enterprise Diversity Development Program, which uses the IDOA approved list of Minority and Women Owned Business as found on their website (http://www.in,gov/idoa). ACTION (ADVERTISEICONTACT): In order for your bid to be deemed responsive, the City of South Bend requires that all perspective bidders complete no less than 2 of the following: E1 Attend all pre -bid meetings scheduled by the City to inform MBEIWBEs of contracting and subcontracting opportunities. 2. Advertise in general circulation andlor trade association publications concerning subcontracting opportunities, and allow MBEIWBEs reasonable time to respond. 3. Perform any and all necessary steps to provide written notice in a manner reasonably calculated to inform MBE/WBEs of subcontracting opportunities and allowed sufficient time for them to participate effectively. Utilize pre-existing services of available community organizations, small and/or disadvantaged business assistance offices and other organizations that provided assistance in the recruitment and placement of MBEIWBE firms. **Bidder must circle or otherwise notate which of the two (2) required actions were performed. GOOD FAITH NEGOTIATIONS: The bidder negotiated in good faith with interested MBEIWBEs, including providing such MBE/WBE's with adequate information about the plans, specifications and other requirements of the subcontract and did not reject MBE/WBEs as unqualified without sound business reasons based on a thorough investigation of their capabilities. SMALL CONTRACT(S): The bidder selected specific portions of the work to be performed by MBE/WBEs in order to increase the likelihood of meeting the MBEANBE goals (including breaking down contracts into smaller units to facilitate MBEIWBE participation) CONTRACT RECORDS: The bidder has maintained the following records for each MBE/WBE that has bid on the subcontracting opportunity: 1. Name, address, and telephone number; 2. A description of information provided by the bidder or subcontractor; and 3. A statement of whether an agreement was reached, and if not, why not, including any reasons for concluding that the MBEIWBE was unqualified to perform the job. *Proper demonstration of Good Faith Effort requires your initials next to all of the above boxes. Any omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of South Bend reserves the right to request additional information. Version 01/29/2020 Contractor's Bid for Public Works - 11 01 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MWBE-2.1 MWBE CONTACTED This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring contacted MBEIWBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business. Project Number: Project Name: Bidder: By: A� 120-001 2020 Curb and Sidewalk Construction PAGE OF MWBE Participation Goal -/;�w 2,69 (Sign9u're5 (Title) (Date) MWBE Firm rwrr- 6,ic,4o--A)61 Owner or Contact at MWBE Firm -`° Z5 /4-9G# ..5 Telephone: j�'7q.,2$7 ,2 Fax: � ,7®17ge( Email: �� ��RR.�cA c•aroasa TYPE OF WORK SOLICITED FOR THIS PROJECT; -T'R,4,9.gzc- 5x-6A15 -i 6 Are-S RESULTS OF CONTACT WITH THE MWBE FIRM: ,i A)lF i> MWBE Firm Owner or Contact at MWBE Firm Telephone: Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MWBE FIRM: Version 01/29/2020 Contractor's Bid for Public Works - 12 Init. CONTRACTOR: (Name, legal status and address) Plerniurri Concrete scniccs. 111c 712 Rachniond St Hildiart, IN46516) OWNER, (Name, legal status and address) City of South Rend Board ol'Public Works OTM SURETY: (Name, legal Status and principal place of business) Old RtpUblic 111SLirance Company Brookfield, WI COUnty-City Building, 13th Floor, Room 1316,227 West Jefferson SOLIth Bend, IN 46601 BOND AMOUNT: Five Percent of the Total Rid 5''i) of Total Bid PROJECT: (Name, location or address, and Project number, if any) 2020 Curb and Sidewalk Corisiruction, Project No. 120-001 This document has important legal consequences. Consultation with an attorney is encouraged with respect to its completion or modification. Any singular reference to Contractor, Surety, Owner or other party shall be considered plural where applicable. The Contractor and Surety are bound to the Owner in the amount set forth above, for the payment of which the Conti -actor and Surety bind themselves, their heir-s, executors, adiniriistrators, 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 firne specified in the bid documents, or within such time period as may be agreed to by the Owner and Contractor, and the Contractor either (l ) enters into a contract with the Owner in accordance with the ter -ins of such bid, and gives such bond or bonds as may be specified in the bidding or Conti -act Documents, with a surely admitted in the jurisdiction of the Project ect and otherwise acceptable to the Owner, for the faithful perforlilance 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 rernain in full force and effect. The Surety hereby waives any notice of air 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 comiection Nvith 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. When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the Project, any provision in this Bond conflicting with said statutory or legal requirement shall be deerned deleted herefrorn and provisions conforming to such statutory or other legal requirement shall be deerned incol1wrated herein. When so furnished, the iritent is that this Bond skill be Construed as a statutory bond and not as a corronon law bond. Signed and scaled this 7lh day of May 2020 "'�rr" in Oncrete ser-vice's. [tic. (Principal) (Seal) (Witness)rpm (Title) Old Republic Insurarico Company CX a)v (Surety),,-, (Sea]) a (Witness) (Title"'' lennifer KaS7 a. Alt(orney in 1, act 1 (1AMIGIC You shaildd slgn ani AIA Clor-Mact tDor, uirne� it, of', 4 1, :ci,ii fts text appears lit RE1.1 An oruglina& assures ffiat c,hanges vvflt not be ob(scured, AIA DOCUrnent A310Tm - 2010. Copyright 9 1963, 1970 and 2010 by The Amencan fin5titUte of Architects. All rights reserved. WARNMG, TiAs MA`' Docuinewit !is Pirotoctod lby 4D& Gopyifigllit t, a% and lnternaVonal rerproducUoin or dWirlibutiori ofthis MA''Diccuaiiprii, or oniy porflart of iit, may remflh liar severe chili and clidminzif pemaliles, and Will hp mxsefc�UDd to the rnaxhimm extent possitile. irrideii the Ilow Purchasers are permitted to reproduce ten ('10) copies of this document when completed To, report copyright violations of AfA Contract Documents, e-mall The American institute of Architects' legal counsel, copyright(g-aia org 06o Ho OLD 11EPL)BLAC INSURANCE (r"ON1,11ANY POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That OLD REPUBLIC INSURANCE COMPANY, a Pennsylvania stock insurance corporation, does make, constitute and appoint: NICOLE L BICKNELL, MEGAN E RIESENBERG, MARK EDWARD WOBBE, BARBARA E PEARSON, JENNIFER L KASZNIA, SANDRA L JUNK, WILLIAM J CERNLY, Ili, WESLEY MANTOOTH, THERESA BURNS, JORDAN SCHEIBER, LISA M THOMAS, FAITH HUNT, OF SOUTH BEND, IN its true and lawful Attorn ey(s)-in -Fact, with unlimited power and authority for and on behalf of the Company as surety, to execute and deliver and affix the seal of the Company thereto (if a seal is required), bonds, undertakings, recognizances or other written obligations in the nature thereof, (offier than selflrusuraince W01ri(e Cornpensaflcm bonds guanaMering paymiemof bc�,nefiU,,, aStWSWS Hbat(UTMd GGintnicl, bands, wastemarmgernent l.mnds, asfo0ows: ALL WRITTEN INSTRUMENTS and to bind OLD REPUBLIC INSURANCE COMPANY thereby, and all of the acts of said ,Attorneys -in -Fact, pursuant to these presents, are ratified and confirmed. This appointment is made under and by authority of the board of directors at a meeting on December 10, 2019. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the board of directors of the OLD REPUBLIC INSURANCE COMPANY on December 10, 2019, RESOLVED FURTHER, that the chairman, president or any vice president of the Company's Surety division, in conjunction with the secretary or any assistant secretary of the Company, be and hereby are authorized and directed to execute and deliver, to such persons as such officers of the Company may deem appropriate, Powers of Attorney in the form presented to and attached to the minutes of this meeting, authorizing such persons to execute and deliver and affix the seal of the Company to bonds, undertakings, recognizances, and suretyship obligations of all kinds, otheir thwa bail bonds, Irank bands, morl[gat3r &afir bonds, rnioi, Rgage quaranty boncJs, guairanl[ees of insLaflinient paper wid note guaranty Imnds, The said officers may revoke any Power of Attorney previously granted to any such person. RESOLVED FURTHER, that any bond, undertaking, recognizance, or suretyship obligation shall be valid and binding upon the Company (i) when signed by the chairman, president or any vice president of the Company's surety division and attested and sealed (if a seal be required) by any secretary or assistant secretary„ or (ii) when signed by a duly authorized Attorney -in -Fact and sealed with the seal of the Company (if a seal be required). RESOLVED FURTHER, that the signature of any officer designated above, and the seal of the Company, may be affixed by facsimile to any Power of Attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shalt have the same force and effect as though manually affixed. IN WITNESS WHEREOF, OLD REPUBLIC INSURANCE COMPANY has caused these presents to be signed by its proper officer, and its corporate seal to be affixed this, day of FEBRUARY, 2020. OLD REPUBLIC INSURANCE COMPANY Ass'! stant r SEAL a 1-0 ", JA Q1 lo4 ----------- STATE OF WISCONSIN, COUNTY OF WAUKESHA - SS Vice President On this 18TH dav of FEBRUARY, 2020 _,personally came before me, ALAN PAVILIC and SHEILA M. APPLEdATE to me known to be the individuals and officers of the OLD REPUBLIC INSURANCE COMPANY who executed the above instrument, and they each acknowledged the execution of the same, and being by me duly sworn, did severally depose and say; that they are said officers of the corporation aforesaid, and that the seal affixed to the above instrument is the seal of the corporation, and that said corporate seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority of the board of directors of said organization, Notary Publ,�c h16 My commission expire,: 9/28/22 (Expiration of notary commission does snot invalidate this instrument) CERTIFICATE 1, the undersigned, assistant secretary of the OLD REPUBLIC INSURANCE COMPANY, a Pennsylvania corporation, CERTIFY that the foregoing and attached Power of Attorney remains in full force and has not been revoked; and furthermore, that the Resolutions of the board of directors set forth, in the Power of Attorney, are now in force. 11), 45-5314 "'I" "sun "'I- Signed and sealed at the City of Brookfield, WI this day of rry ",,OR1OOA"A.. CW SEAL °tero" Assistw re. a ry GIBSON INSURANCE AGEUCY, INC. 2285 POAORI 01/2020 1316 COUNTY-01-Y BLJ1I DING 227 W, JEFFERsoN BOLJI_FVARI) ,�Cl[fTI I RFND. INDIANA 46601 -M30 PEACE _ x x CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD Of, PUBLIC WORKS May 21, 20I9 Max Yeakey Premium Concrete Services, Inc. 712 Richmond Street Elkhart, IN 46516 RE: Pre -Qualification Verification Dear Mr. Yeakey: NIONS 574/235-9251 FAX 574/ 235-9171 This letter serves as verification of Pre -Qualification status of your company for bidding with the City of South Bend. This Pre -Qualification status is effective for twelve (12) months from the date of this letter. Thereafter you are required to re -submit a complete application for continuation of pre -qualification status prior to December 31 for the upcoming calendar year. A copy of this Verification Letter must be included with every bid exceeding $150,000 submitted to the City of South Bend Board of Public Works, along with your Pre -Qualified Bidder Checklist and attachments. If you have any further questions regarding this matter, please call this office at (574) 235-925I . Sincerely, Linda. M. Martin, Clerk GARY A. GILOT GENEVIEVE E. MILLER ELIZABETH A. MARADfK LAURA L. O'SULLIVAN THERESE I. DORAU When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit. CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON- DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS (Must be completed for all quotes and bids. Please type or print) STATE OF A } } SS: OLKHRrp! ' COUNTY ) The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury that: 1. Contractor has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid is trade without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and 2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency; and 3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investment activities inIran. a. For purposes of this Certification, "Iran" means the government of Iran and any agency or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from tithe -to -tithe. b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor is engaged in investment activities in Iran if either: i. Contractor, its successor or its affiliate, provides goods or services of twenty million dollars ($20,000,000) or more in value in the energy sector of Iran; or ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty million dollars ($20,000,000) or more in credit to another person for forty-five (45) days or more, if that person will (i) use the credit to provides goods and services in the energy sector in Iran; and (ii) at the time the financial institution extends credit, is a person identified on list published by the Indiana Department of Administration. Version 01/29/2020 Contractor's Bid for Public Works - 4 4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the Contractor subsequently learns is an unauthorized alien. Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of Contractor's newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3. Contractor's documentation of enrollment and participation in the E-Verify Program is included and attached as part of this bid/quote; and S. 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 1 -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 he required to award a subcontract to an--MWBE; however, they may not unlawfully discriminate against said MBE/WBE. A finding of noncompliance or a discriminatory practice shall prohibit that Contractor from being awarded a City contract for a period of one (1) year from the date of such determination, and such determination may also be grounds for terminating the contact to which the discriminatory practice or noncompliance pertains. 7. The undersigned Contractor agrees that the following nondiscrimination commitment shall be made a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its agencies, boards or commissions. Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the performance of this contract with privileges of employment, or any matter directly or indirectly related to employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation, handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of contract. 1, the undersigned bidder or agent as contractor on a public works project, understand my statutory obligations to the use of steel products or foundry products made in the United States (1.C. 5-16-8- 1). I hereby certify that l 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 ajustification 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 detennination if the price of United States made steel or foundry is unreasonable. 1 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 infonrnation contained in the foregoing bid for public works are true and correct. Dated this I day of MA) , 20 Db llxtmi�tal 6,qC1)ck 71C Contractgr/Biddet (Firm) Signature lo-f Contractor/Bidder or Its Agent Printed Name and Title Subscribed and sworn to before me this i D 4A day of MA� , 20 J-6 My Commission Expires 01 0 � �— }t?- ..�, F) I L b N ary Public County of Residence`s JANEE MTOWNER NOTARY PUBLIC SEAL ELKHART COUNTY, STATE OF INDIANA W MMISSION EXPIRES FEBRUARY 12, 2026 COMMISSION NO.710399 Version 01/29/2020 Contractor's Bid for Public Works - 6 i 0 r BUSINESS INFORMATION i CONNIE LAWSON ( 1NDIANA SECRETARY OF STATE I 04/30/2020 02:37 PM 1 Business Name: PREMIUM CONCRETE SERVICES, INC. Business ID: 2004120100105 Entity Type: Domestic For -Profit Corporation Business Status: Active Creation Date: 11/24/2004 Inactive Date: Principal Office Address: 712 RICIIMOND ST, ELKHART, IN, Expiration Date: Perpetual 46516, USA Jurisdiction of Formation: Indiana Business Entity Report Due 11/30/2020 Date: Years Due: ��,.�-.,,?,��.4..r.�.. ...f...'. ,,.� ... .:.�. ?^,... .r-..,,,�.N"� '%�r!'K, >,.-s'r,-✓f�Jz v ! .�, ..�N,�`.s�r z"�.�� ,'". Title Name Address President Becky L. Yeakey 712 Richmond Street, Elkhart, IN, 46516, USA Vice President Max A. Ycakey 712 Richmond Street, Elkhart, 1N, 46516, USA f x �_. � � r2,�> ✓ � _ � c , _ :ate � � � �, ,�, ^'S ���,,���"�,✓ Name Title Address MAX A. YEAKEY Incorporator 1737 CRABTREE LANE, ELKHART, IN, 46514, USA }teglStered��en"��n�'o�matloel ;.x ,,, xr> ' ,:--', ✓ ��"��7 ^• 3�. ' �s� ��X '���z- Type: Individual Name: MAX A. YEAKEY Address: 712 Richmond Street, Elkhart, IN, 46516, USA Premium Concrete Services, Inc 712 Richmond Street Elkhart, IN 46516 574-264-0196 fax 574-266-5392 04/30/2020 To Whom it may concern, Premium Concrete Services, Inc. currently employs 24 people, 4 of which are field supervisors, 7 concrete finishers, 10 laborers and 3 heavy equipment operators. We are signatory to the local Cement Masons, Laborers and Operator's unions through which extra employees can be pulled from when needed. Max Yeakey VP R-39514 LaSalle & Marquette south Bend INDOT $ 210,779.59 Sidewalk, ADA compliant 1902 T 40046-A Traffic Signals Ft. Wayne INDOT $ 199,735.00 Curb, curb & gutter, sidewalks, HiVIA patching, PCCP patching, curb ramp, 1914 detectable warning surfaces South Bend Waterworks South Bend City of South Bend $ 79,121.00 Various concrete/asphalt utility repair work 1936 R-40913 Howe, IN SR 12 Howe INDOT $ 57,989.85 Concrete A substructure, Concrete B footings, reinforcing bars epoxy coated. 1929 City of Elkhart - Various Elkhart City of Elkhart $ 70,171.85 Various concrete curb, sidewalk & sitework 1904 DavIrlA, Fjw deriyJ BOA Clair I. Guert'er'o Ririkv 11077son, A. Rctw,ors Uei*oai , A, Ii0D2i7rS. 1'�rrlaJ?L RO. Box 75 - Bcd&A, indWa 47121 (812) 279-9751 Mi ty 20, 2 01,9 ,l,cr whom it May. con.ccrfl: ,Sean Coa,1(18y, MP2Ctor Alm A Rtown cI7Cdii7rlan Kefy 21 b e I Brad-Dreibel&,7 Michael Poem,v ,S/an Meyet' dyl f7TrWM0.2 This lctmr is [O coldim, that Coi'iG.i'dc arr VlC1r,S, ifif— is a. ss.t.g=llatory (�Oil(a'ad.] ,w lti good �, lbm..ldillg w1L7 €11k, Incli,-ma l AbQ:1:tvs' Tjim ling Tu).,-A T'LLl1Cl. The above �.m-npwny is 2 p"Irticipzrrtf. ill. dic .tohil : d 'I')`aining. Commi.Li. a tl-r:crtrgh Us UtAm and has heen an a,c ve paoici ant. in goccl. ,Stamm ling l:or cach of th past [ IVF.`• Pius consectrtiw- yc�.trs, and is eurrently eligible Lo rise on a. project, rtrr€titer, our arga.nizadon's program is appioved by th(- f�,;�. Vot(x'a s Adtrv.rtis[mciotl To pa •tiryda bi he CI educa.tio). t benefi[s program, A copy of our approwil lettevs nxe mgached. 'llosig. vlfth f[tr_ colt. ove bargairzictg agrcomexil. siatutg fire ratios of.lou icy workeis t nl�i�retEic. ;s, �,vl)iclt zs one �1ptertCieu for evc.y live (.5) .lortrrc;y urnr_l ers atacl tllc.tea%e; naay not employ Snore that (l) Apprentice for cvcr;r (3) Jounicy wofZers. 7 p� f secr.tr Caal4iey E rector ", Cn wimrrw. iodiopwlab ore, W-1 � IELi Ca �F) ON cl CI s STATE OF _ ME 6E—P i—TMENTOF VETERANS AFFAIRS STATE APPROVING AGENCY 402, WEST WASHING T ON STREET ROOM V1469 INDIANA€ OI_#S, IND€ANA 46204-27-18 15 AJ App•enfico laip Coordinator ud.iana L abamrs Training TiustFu d. Apjp e ticosliip 439 Patton ffill Fed, Dcdf'ord, IN47471 HG Holcomb, Governoi` James M. Bromi. director 3arlttary 91 2019 T11is 170 l ackuowledg� cecei,l-A orycrru- updated W Mgt Sv�al,x for the '>'I aborcv progran�l_ o feed by Il:lzliGM<0. F,aai r;r.; Agoacy .h.as rewBz 7?-oc!_ Me ciocuraeq,)listed heEow� Wngc ; i PAf:Jlft 1T Y i:ODY, 300041/4 'Fo the b es[ of fay kaowl�Agt) Lacliaiv Labotor,, Train -hog does not. -uti.tlze; uron,,ous or n islcading � , vardstllaufr[, , iWlel- lay act€ial 5f:aterrtea[ oo- s,sioi i, or TntimativaT-t is rir.tdersr. od by fadia112. Laboxel's `-va:illiTlg ,hust:1' rrrd Ah ���,�rticesl>i7.7that they will ma nf� iha i (soraplde record ofah advertises,,; uti.lize,d by or on b6b 1.1f of 1fic Tl-ust in regards to [Loki trainag progiuns during The preceding l)- m(Afi:lus. 1ri�cl.iaaa Ud)o.rcrs Traking Trust Fttj�ti actva ismg will b, avaIu bz; Tar reviavv by aj:l:y a nd all f s lixe st perviso.l y visits ley the ISA.A, cal: 1:h.t TT , Dopax[l eut of oiet,i rau Ajdbb;s, Tlca8c .0 ovie- w €'hf- cntve pacicol; fo1' ronfc3it ald accuracy, A) pi -oval is },n 2m.ted tia s umal to th.G pravislons of 1).de. 38, US, Coc#r a637, with an efi'ective. dale, of April t, MIPS, 1T" .YdL1 'h.UVO Xfly cfrtcst:i.on:s, pfe;:,se t�el fl-cc to give me (,�ill at .317-J 32-39I G or z j:-a,-d1nt r• wri f,mr, )(1va in gov. 1Ll��lr1<_. you ('Or what yotr r. o ._O:C oLTY 711e 11flVe a Ype A day. Tt@.:ruiqua, GAffill E'r:oL�aill L)1xecto�,,- State Approvitlg 11-micy Cw V ARO/PIR. STATE DEPARTMENT OF VETERANS AFFAIRS STATE APPROVIMG AGENCY 402 WES i WASHINGTON STREET ROOM W-460 INUTANAPOLIS, INDIANA 40204-2733 J erc rrry B re tinvel.. A.pi'mi3da;ship Coordinator >�1c1i�.�����.i�a�:e�s d39 .Patton Hill Rd.. f?Fdtor•d, IN 0421 E& Holcomb. acvemor .lames M. 13rokim, Director kmlumep 9, 2019 ')_'he Inchana S{:at:e Approving / g.noy c-o:ncl.rrctccl i sopervisory visit: on 01.1800.1.9 al IndlCrna [.,ahorers T3-lhlifag Tares[ Fuud-Appftat.i.ct' ihit7. Tht purpose of`tlae v6it v n to hrov de: t:rataing to sale O fic"ials and review n[l7ollrraetxl: ce'virf` o ticn s, record t_et,oti.oa and rop r€ ng prncCI:.t LD S. T'ILQ 0rg�rrli7a.1i0U derrIor S11 ftg d h'roper 1:ecord a-mirrtenance xiid record. r-Llabrtellan(a t al)ci r•epor ling �r�:Dcecfta.r; s, Dur•in„ die visif, vve disc ssecl tLe, iulpollant.a ofrGporting flours 011. a montw.,y h,:1sis, gmod record keep inn tea- ch nques, ad. how Co report aleave of aba,, tce or, c;omplertioja via VA 1: ogre ?2-1999b, We also updated the Ctl liiying Of,icial., via VA -Form 22.9794, vvork Processes, as.A wage sera le. if yolr rre:ed any assistance or have airy cluestiorrs regarding this tec:.(lAie;al visit plAa,se co;T[Wt mc- direc fay at tpLriff n@dva.in.gpv or (31 ) 232 3915. TL1aa�fe you for Ifie �ouflccsy e t�rar,{ed rillyffig rfl y- vi.s i. C`l:ae odrrc tioaa a_nd Inainina op portuniii.es that Your organi"fiorr eolatintles to ):rwvide vdcrall aar�. t1a it deporr.dents ase appf(r dated. SiLcE�v-lyn prog€-terra Director Phones, (317)-234I-6062 `Toll Free (8OD)-400-4520 Fax (317)-234-53744 STATE OF INDIANA DEPARTMENT OF VETEPAN8 AFFAIR STATE APPROVING AGENCY 402 VVEST X(VASHINGTON STP%El r BOOM W-409 INDIANAPOLIS, INDIANA 462N-2738 Jt;rQ1-ay Brt*va Apprmaticeslaip Coordiritat:or Tirdh oa Labor'cas Traiaiing Tru8t Rawcl 4Nppr'enticc,,s11ala 439 Patton bill Rol, B cd:Ford, f 47421 Dca.t_ Jeremy Bre'—wer, Eric Holcomb, Governor Jaynes M. Brown, Director Jaaatuuy 9, 2019 T'llis Will :'-Lc1U.1.oVV.lef1,c, rc (,-r j.7t oF your rceA' e fat ffic cou pitruct.iou cra-ft j1ab ➢.€cr pyn—g"Tam o'(-FE'.f'ed. EI.L 1001" er Elli=;:I:E�Y�",:.�.OG 'I'F,� Li ��FC{�4�}"(�; -h li.aa i, T'.hc-. Approvi.tig Aff,Dcy leas revi,ewtd. the cl.octl:isaeof,'m .ii,sted below:. '1 ��t.{.€.ia�o����Cat_Il ��k . _ �--------�,.....,� ; ?l rP# 'f It . OD+, 4..000-7800" ki.oril,s 417-2061.00 'T'O tho lac,st o,(-r'rrylc_1o4f.e('.lf7r l_udiast.a f aborus T'aia.irig'ffusL ip does Lot uf lire erroitr. ous or za.lisleadir)g acLverdserauut, either by a.cha<a1 stc:l mc21t, omission, Or h is mrcl.ei,7tond by ltncliarra Labor ns Tr°al:r6tig Tarst I UTatl-Apiirel ttic.eshtt tF ail: fliq, i i mai_ntairl a cai�aplc.f:c 3'erer'cl'of all. a.dvet'tisir,g tltiiizecl by or orr l,elaal of"tlrc. cor7'+par y in regards to their I:raiyziiig p-rograrxi.s chrxitg ti-te prtcccdi-ttg 12 mmitlas.. T'hc lsolrapa.vT acbqeilhi.ng will be, uvailahlr for reVi.O%A/ b, jury a.€ d, all futu:o' . supervi.,soly visits [ay kiao S/- , or fhe US, Delay+.t'l:tatcayt az Vcrcvarr Aff,-drs Trris �;j1�ro� ail .i> ; uudc . �mitl.�mt to mid.. r_incl_er the ', pj.'m isiof as, of `4.`.i-1:f.{ : S US- - Code 3687, %Vj,.-h cafoc;U-;rc. ctate Of 311-mu".Ky 8, 2019� IF.j�cau.lrave quay c��iesiinats, i>I,n��se cUrAl:at.;i:,�i,u aa.31%-2,'3�,-3�11(i. slrce'Ie y, Tarliclaaa, c xif.�'i,t] 1'rop-aol Director 4: c:ltA.AW/P'l,k. Plionc (3 L7)-234-GOG2, ToJ1 Free (900)-400-4521? 1316 COUNTY-01-Y BLJ1I DING 227 W, JEFFERsoN BOLJI_FVARI) ,�Cl[fTI I RFND. INDIANA 46601 -M30 PEACE _ x x CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD Of, PUBLIC WORKS May 21, 20I9 Max Yeakey Premium Concrete Services, Inc. 712 Richmond Street Elkhart, IN 46516 RE: Pre -Qualification Verification Dear Mr. Yeakey: NIONS 574/235-9251 FAX 574/ 235-9171 This letter serves as verification of Pre -Qualification status of your company for bidding with the City of South Bend. This Pre -Qualification status is effective for twelve (12) months from the date of this letter. Thereafter you are required to re -submit a complete application for continuation of pre -qualification status prior to December 31 for the upcoming calendar year. A copy of this Verification Letter must be included with every bid exceeding $150,000 submitted to the City of South Bend Board of Public Works, along with your Pre -Qualified Bidder Checklist and attachments. If you have any further questions regarding this matter, please call this office at (574) 235-925I . Sincerely, Linda. M. Martin, Clerk GARY A. GILOT GENEVIEVE E. MILLER ELIZABETH A. MARADfK LAURA L. O'SULLIVAN THERESE I. DORAU i 0 r BUSINESS INFORMATION i CONNIE LAWSON ( 1NDIANA SECRETARY OF STATE I 04/30/2020 02:37 PM 1 Business Name: PREMIUM CONCRETE SERVICES, INC. Business ID: 2004120100105 Entity Type: Domestic For -Profit Corporation Business Status: Active Creation Date: 11/24/2004 Inactive Date: Principal Office Address: 712 RICIIMOND ST, ELKHART, IN, Expiration Date: Perpetual 46516, USA Jurisdiction of Formation: Indiana Business Entity Report Due 11/30/2020 Date: Years Due: ��,.�-.,,?,��.4..r.�.. ...f...'. ,,.� ... .:.�. ?^,... .r-..,,,�.N"� '%�r!'K, >,.-s'r,-✓f�Jz v ! .�, ..�N,�`.s�r z"�.�� ,'". Title Name Address President Becky L. Yeakey 712 Richmond Street, Elkhart, IN, 46516, USA Vice President Max A. Ycakey 712 Richmond Street, Elkhart, 1N, 46516, USA f x �_. � � r2,�> ✓ � _ � c , _ :ate � � � �, ,�, ^'S ���,,���"�,✓ Name Title Address MAX A. YEAKEY Incorporator 1737 CRABTREE LANE, ELKHART, IN, 46514, USA }teglStered��en"��n�'o�matloel ;.x ,,, xr> ' ,:--', ✓ ��"��7 ^• 3�. ' �s� ��X '���z- Type: Individual Name: MAX A. YEAKEY Address: 712 Richmond Street, Elkhart, IN, 46516, USA Premium Concrete Services, Inc 712 Richmond Street Elkhart, IN 46516 574-264-0196 fax 574-266-5392 04/30/2020 To Whom it may concern, Premium Concrete Services, Inc. currently employs 24 people, 4 of which are field supervisors, 7 concrete finishers, 10 laborers and 3 heavy equipment operators. We are signatory to the local Cement Masons, Laborers and Operator's unions through which extra employees can be pulled from when needed. Max Yeakey VP R-39514 LaSalle & Marquette south Bend INDOT $ 210,779.59 Sidewalk, ADA compliant 1902 T 40046-A Traffic Signals Ft. Wayne INDOT $ 199,735.00 Curb, curb & gutter, sidewalks, HiVIA patching, PCCP patching, curb ramp, 1914 detectable warning surfaces South Bend Waterworks South Bend City of South Bend $ 79,121.00 Various concrete/asphalt utility repair work 1936 R-40913 Howe, IN SR 12 Howe INDOT $ 57,989.85 Concrete A substructure, Concrete B footings, reinforcing bars epoxy coated. 1929 City of Elkhart - Various Elkhart City of Elkhart $ 70,171.85 Various concrete curb, sidewalk & sitework 1904 DavIrlA, Fjw deriyJ BOA Clair I. Guert'er'o Ririkv 11077son, A. Rctw,ors Uei*oai , A, Ii0D2i7rS. 1'�rrlaJ?L RO. Box 75 - Bcd&A, indWa 47121 (812) 279-9751 Mi ty 20, 2 01,9 ,l,cr whom it May. con.ccrfl: ,Sean Coa,1(18y, MP2Ctor Alm A Rtown cI7Cdii7rlan Kefy 21 b e I Brad-Dreibel&,7 Michael Poem,v ,S/an Meyet' dyl f7TrWM0.2 This lctmr is [O coldim, that Coi'iG.i'dc arr VlC1r,S, ifif— is a. ss.t.g=llatory (�Oil(a'ad.] ,w lti good �, lbm..ldillg w1L7 €11k, Incli,-ma l AbQ:1:tvs' Tjim ling Tu).,-A T'LLl1Cl. The above �.m-npwny is 2 p"Irticipzrrtf. ill. dic .tohil : d 'I')`aining. Commi.Li. a tl-r:crtrgh Us UtAm and has heen an a,c ve paoici ant. in goccl. ,Stamm ling l:or cach of th past [ IVF.`• Pius consectrtiw- yc�.trs, and is eurrently eligible Lo rise on a. project, rtrr€titer, our arga.nizadon's program is appioved by th(- f�,;�. Vot(x'a s Adtrv.rtis[mciotl To pa •tiryda bi he CI educa.tio). t benefi[s program, A copy of our approwil lettevs nxe mgached. 'llosig. vlfth f[tr_ colt. ove bargairzictg agrcomexil. siatutg fire ratios of.lou icy workeis t nl�i�retEic. ;s, �,vl)iclt zs one �1ptertCieu for evc.y live (.5) .lortrrc;y urnr_l ers atacl tllc.tea%e; naay not employ Snore that (l) Apprentice for cvcr;r (3) Jounicy wofZers. 7 p� f secr.tr Caal4iey E rector ", Cn wimrrw. iodiopwlab ore, 40 af.� Ill 0 0 „ t W < ,3Z Z _ c) I'A €� Uj �. UA n {{ (": IUJ IA II iij IAJ. q) aj ti C aye .ti y CITY OF SOUTH BEND, INDIANA x CONTRACTOR'S BID FOR PUBLIC WORK CHECKLIST FOR BIDDERS Project Name 2020 Curb and Sidewalk Construction Project No. 120-001 For Bids Due May 12, 2020 at 9:30am 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. ,}Proper bid security included. The bidder has the option of providing either a Certified Check or Bid Bond. �, , O Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely �j executed. Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments I! with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and Certification of use of United States Steel Products or Foundry Products. Proof of MWBE Utilization Plan [MWBE-1.0]. If minimum participation goal is not met, also provide Evidence of Good Faith Efforts Form [MWBE-2.0] and MWBE Contacted Form [MWBE-2.1]. !� Acknowledge Receipt of Addendum(s) included with the bid. JJ�� � L J All required additional information is included with the bid. /J Proposal statements and other affidavits all signed by the proper party with name either h printed or typed underneath signature. O This checklist submitted with the Bid. This checklist is provided for bidder's use in assuring compliance with required documentation; however, it does not include all specifications requirements and does not relieve the bidder of the need to read and comply with the specifications. Bidder:)V[QMxe4A.)cA&7E AV-Z5 =0C_ Date: 5-// .2 /.2 C-� By Authorized Representa ive: Signature: Print Name & Title: W�i,A��ey Version 01/29/2020 Contractor's Bid for Public Works - 1 FART II (For projects of $100,000 or more — IC 36-1-12-4) These statements to be submitted under oath by each bidder with and as part of his/herlits 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 10 it3i F! Q ; o C:J C'.'.i ca C FW) ,:• (,1 € © 0 o o u • � I I CE _ - � f a El c'•5 fl !` i �I Ctii E c I s f~ , C37 'cj- [73 I LC3 ? l V !Y i- I CQ LO co 03 07 '�i- .r_ •t (�I (L CL7 �i Ck L(.}_ c7 r'D '4 [ 0 i 3]; >, III fff 1 �{ 12 co r_7 �.. I i�3 c li I by �I I nl I - I LfJ 1. T-• i]t f q ,n 11 o b ry! O I CI' > U (.:D fJ I Ct M I % I c}-) c"J I 1`- I r=7 cp on ! 13 EI I g f} c I� `I r _ JI __I{ �J It i� q -",k o cr, U co3 ie, i E Fp � C'i' 49 �l i C9 �-. `� X3 t�93i G.?,j y CD( r-• I C7 l{ C�! to ii7 f i ' :oil al Lx7 nl t.C) �i. �'. t�! 01 t�Y ii cn n I ni'` €' n3 I ra i f'` cc f jj E I } 3 E-f� I Q � r• i CO Chi + ' I Ic'; l 1 m: f 77 I ; i U 1 rT, 7f "-f ! J [ I �•� cif [� I ��� ...i r>3 .-�-j Z"A:j tlE 3 1 , I I-T4 • �] j �•;,` 'I� �n f c- : r.+� j rn i c�� rn c_a i c > � - � c� # Erj `:_ { Lrl j Cam': n E{y is i (fit I C�)I t>I NI If7 10 iT It S6 cy I 0 to 4-- .`3 I a : , E - I .11 ) �., Ol i LJ tits ; c r t LU t l t. III r JI C) i I =,- 4 of mk Ei I r i - 111 LA I I I 1 I 1 II r an f W i & ;3 - \ N- " � C'<£ � dal e 3 Plasterers' & comeW masons, Apprenticeship Goordiriator beau: Union �692 Phone: (219) 7€37 7767 Ernail: bkristaff@Plcraloc11692.org TF?$@1NhNii1 lrkc-. P.5 PA sigrlla'tory canotrazic . r �Aijirti fj.)(�3 (s 2 r3 N P�2,'Iif,cpate-, in U-ie Plasterer:y €fir. Cement Masons a MY b C r ea GE i I at i` : )7- '7(-,7 : c€dditr�i�a€ i€iineeded, Thank you, Brian Kristoff Iery illv€IPA, N"� iana 4 6 4 � I o 712 Richimond Street Elkhart, IN 46516 (574) 264-0196 SECTION I PLAN AND EQUIPMENT QUESTIONAME 1,) PUBLIC WORKS PROJECTS COMPLETED IN PAST YEAR: CONTRACT AMOUNT COMPLETION DATE OWNER $ 108,332,00 ADA CURB & SIDEWALK 10/2019 CITY OF ELKHART $199,735,00 CURB RAMPS&SIDEWALK 10/31/19 INDOT $211,721.59 SAFE ROUTES TO SCHOOL 8/12/19 INDOT 2) PUBLIC WORKS PROJECTS IN PROGRESS: CONTRACT AMOUNT COMPLETION DATE OWNER $ 295,285.00 $ 208,900,00 IRONWORKS PHASE 1 ADA CURB & SIDEWALK 6/19/20 10/31/20 CITY OF MISHAWAKA CITY OF ELKHART 3) HAVE NEVER FAILED TO COMPLETE ANY WORK THAT WAS AWARDED TO US. 4) REFERENCES: a. NISOURCE —MR. LUKE BRADLEY— 1039 PENNSYLVANIA AVE SOUTH BEND, IN 46601 b. LOZiER MANUFACTURING —MR, KEN MURR-402 N MAIN MIDDLEBURY, IN 46540 29 712 Richmond Street Elkhart, IN 46516 SECTION 11 PLAN AND EQUIPMENT QUESTIIONAIRE 1\ Project No. 120~O812O38Curb QSidewalk Construction -Schedule: After given, the notice to proceed Premium Concrete Services, Inc. will create a letter to hand out toresidents with details ofupcoming work. pC5will then contact Indiana 811tmlocate all utility lines within construction limits. Layout and staking ofsite will benext. Then removals, excavation, grading &subgradewill begin for concrete work, After excavation and grading phases are complete, cmmcretework will commence. Crews of4-6workers will install, Finally top soil and seeding, fnNmvvedbytree planting atthe appropriate time. Project with becmnmp|etedom schedule. 2) a\ TCSInc. —181UW.Pacific Ave. Knox, IN 48534—Traffic Maintenance, Signs and Thermoplastic Lines. b) Acorn Landscaping —388DVVSample StSouth Bend, |N 46629—TopSoil and Sodding. c) KacburTree Service, LL[-316FuKkemnnRdNiles, M|49218-Tree Removal. d) Walsh & Kelly Inc, —24358|N-]3 South Bend, UN46614—Asphalt Paving, e) 0itschandBrothers, Inc. —1204VV.Sample St. South Bend, UN 46619—Removals f) K[Tree, Inc —8913 East USHm/y20New Carlisle, VN 4G552—Tree Removal g\ FmerbrimgerLandscaping —32530Brick Road SputhBend, |N 46628—Top Soil and Sodding. Premium Concrete Services, Inc. Does not requ:ire bonding for its subcontractors 3) Will supply list ofsubcontractors soon after award ofproject. 4) Equipment use for project: Bobcat, Mini Excavator, Excavator, Compactor, Roller, Walk -behind Saw, Cut-off Saw, VibraStrike, Dump Truck, Current pKanistoused owned eqmipnnent, however depending onworkload some rental equipment may benecessary, 5) Yes, Premium Concrete Services, Inc. has quotes for all materials in proposal. Premium Concrete Services, Inc. Elkhart, Indiana Annual Report December 31, 2018 Contents Report Q Independent AcyounbG on Financial S tale emeG. Financial Statements Statement Q Income and Rd%nedEambga�......... .......... ........ 2 Balance Sheet ... ............................3 State of Cash Flo ..................... 4 Notes to the Financial Statements................5-8 Supplemental Schedules .. . . . . . . . . . . . . . . . 9-]0 To the Goard of Directors Premium Concrete Sen/ioes, Uno. Elkhart Indiana | have reviewed the accompanying financial statements ofPnsmium Concrete Services, Inc. (am 8 oorpmration), which comprise the balance sheet aoofDecember 31.2O18and 2O17,and the related statements ofincome and retained earnings and cash flows for the years then ended, and the related notes tothe financial sbetemontw� A review includes primarily applying mmm|ytita| procedures hzmanagement's financial data and making inquiries of company management. A review is substantially less in scope than an audit, the objective of which is the expression of an opinion regarding the financial statements as a whole. Accordingly, | do not express such an opinion. Management's Responsibility for the Financial Statements Management is responsible for Uhe preparation and fair presentation of these financial statements in accordance with accounting principles generally accepted in the United Stzbaa of Amahms� this includes the dookJn, imp|emenbation, and maintenance of internal control relevant to the preparation and fair presentation of hnenoie| mtabamantm that are free from material misstatement whether due to fraud or error. Accountant's ResponsWfty My responsibility is to conduct the revipw engagerrient in accordance with Statements on Standards forAccounting and Revew Services promulgated by the Accounting and Review Services Committee of the A|CPA. Those standards require nnehoperform procedures boobtain limited assurance as abaoinforreporting whether |mmaware of any material modifications that should be made to the financial statements 'For them to be in accordance with accounting principles generally accepted inthe United States ofAmerica. Ibelieve that the results ofmyprocedures provide areasonable basis for myconclusion. Accountant's Gonclusiion Based on my review. | am not aware of any material modifications that should be nxzde to the accompanying financial statements in order, for them to be in accordance with accounting principles generally accepted in the United States of America. Supp�ementary Information Fhesupplemenbary information included in Schedules | and U is presented for purposes ofadditional analysis end ianotarequimadpodofthebesicfinsnoim|sketements. The information i»the representation ofmanagement, |have reviewed the information and, based on my review, | am not aware of any material modifioationa that should be made to the information in order for it to be in accordance with accounting prinoip|msAonenaUy accepted in the United States ofAnnerica, | hmve not audited the inhzrmaUon and, acoordingly, do not express an opinion on such AnthonyP. Dibley, CPA, PC. ' Elkhart, Indiana February G'2018 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 05/20/2020 Name Alicia Czarnecki Department Engineering BPW Date 05/26/2020 Phone Extension 5903 Review and Approval Required Prior to Submittal to Board Diversity Compliance ❑ Officer Name and Inclusion Officer BPW Attorney ❑ Attorney Name Dept. Attorney ❑ Attorney Name Purchasing ❑ Check the Abbrobriate Item TvDe — All Submissions U Professional Services Agreement U Contract U Proposal ❑ Open Market Contract ❑ Amendment/Addendum ❑ Special Purchase, QPA ❑ Bid Opening ® Bid Award ❑ Req. to Advertise ❑ Title Sheet ❑ Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes ❑ Proposal Opening ❑ C/O & PCA No. ❑ PCA ❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution n Other: n Ease./Encroach Information Company or Vendor Name Premium Concrete Services, Inc. ❑ Yes ❑ If Yes, Approved by Purchasing New Vendor ❑ No MB❑ Yes MBE/WBE Contractor E Completed E-Verify Form Attached ❑ ❑ No Project Name 2020 Curb & Sidewalk Project Number 120-001 Funding Source MVH Account No. 202-06-602-505-431000 Amount $202,213.00 (Divisions B1, B2, B3, C1, and D1) Terms of Contract Unit Price Not To Exceed Purpose/Description Award Divisions B1, B2, B3, C1, and D1 of 2020 Curb and Sidewalk Program For Change Orders Only Amount of ❑ Increase $ ❑ Decrease ($ ) Previous Amount Current Percent of Change: New Amount Increase % Decrease ( % Increase % Total Percent of Change: Decrease % Time Extension Amount: New Combletion Date: 1316 COUNTY -CITY BUILDING 227 W.JEFFERSON BOULEVARD SOUTH BEND, INDIANA 46601-1830 CITY OF SOUTH BEND JAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS May 26, 2020 Mr. Bill Favors Ziolkowski Construction, Inc. 4050 Ralph Jones Drive South Bend, IN 46628 zb:u:fl:.:.:..,c,orn PHONE 574/235-9251 FAx 574/ 235-9171 RE: Award Bid — 2020 Curb & Sidewalk Construction — Project No. 120-001 Dear Mr. Favors: The Board of Public Works, at its meeting held on May 26, 2020, awarded the above referenced project to Premium Concrete Services, Inc., in the amount of $202,213 for Divisions Bl, B2, B3, Cl, and Dl; and Rieth-Riley Construction Co., Inc., in the amount of $168,007 for Divisions Al, A2, and D2. Thank you for bidding, and we hope you bid with us in the future. 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. DORAU JORDAN V. GATHERS JOSEPH R. MOLNAR 1316 COUNTY -CITY BUILDING 227 W.JEFFERSON BOULEVARD SOUTH BEND, INDIANA 46601-1830 CITY OF SOUTH BEND JAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS May 26, 2020 Mr. Dustin Hillary Walsh & Kelly, Inc. 24358 State Road 23 South Bend, IN 46614 PHONE 574/235-9251 FAx 574/ 235-9171 RE: Award Bid — 2020 Curb & Sidewalk Construction — Project No. 120-001 Dear Mr. Hillary: The Board of Public Works, at its meeting held on May 26, 2020, awarded the above referenced project to Premium Concrete Services, Inc., in the amount of $202,213 for Divisions B1, B2, B3, C1, and D1; and Rieth-Riley Construction Co., Inc., in the amount of $168,007 for Divisions Al, A2, and D2. Thank you for bidding, and we hope you bid with us in the future. 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. DORAU JORDAN V. GATHERS JOSEPH R. MOLNAR