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Home My WebLink AboutOpening of Bids - Speed Hump Installation Bid Proj No. 120-043 - Walsh & Kelly, Inc.CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK CHECKLIST FOR BIDDERS Project Name Speed Hump Installation Bid Project No. 120-043 For Bids Due August 11, 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 X or Bid Bond. Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely X executed. Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and X Certification of use of United States Steel Products or Foundry Products. Proof of MBE/WBE Participation Goal Form [MWBE-1.0]. If minimum participation goal is not met, also provide Evidence of Good Faith Efforts Form [MWBE-2.0] and MBE/WBE Contacted X Form [MWBE-2.1]. X Acknowledge Receipt of 1 Addendum(s) included with the bid. ® All required additional information is included with the bid. Proposal statements and other affidavits all signed by the proper party with name either X printed or typed underneath signature. X This checklist submitted with the Bid. This checklist is provided for bidder's use in assuring compliance with required documentation; however, it does not include all specifications requirements and does not relieve the bidder of the need to read and comply with the specifications. Bidder: Walsh ................................................................ By Authorized Rel Signature: Print Name & Titl n Hilac. VP of South Version 4/2/2019 Contractor's Bid for Public Works - 1 Date: 8/11 /20 CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK Address: 24358 SR 23 City/State/Zip: South Bend IN 46614 Telephone Number: ( 574 ) 288-4811 Agent of Bidder (if Applicable): ,....., -----------------__. Pursuant to notices even the under - --------------- g signed offers to furnish labor and/or material necessary to complete the public works project of: Speed Hump Installation Bid the City of South Bend, Indiana, in accordance with plans and specifications prepared by: .-.._ - --- Troffer rout ......... ............................... _................ _. and dated 7/14/20 for the sum of (enter the Total Bid as shown on the Proposal) Two hundred ei� three thousand wone whundred sixteen dollars and zero cents �$ 283,116.00 _._..... (Enter sum of Total Base Bid plus Alternates shown on Proposal) (Numerical) The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the notice. Any addendums attached will be specifically referenced at the applicable page. If additional units of material included in the contract are nfx�`�8, , shown in the original contract if accepted by the City,of"`S,a ith B basis, the itemization of the units shall be shown o ,a,;%,6parat By Dustin Hlla th 1 cost of units must be the same as that If the bid is to be awarded on a unit (Signature) VP of South Bend Area Y4 ® .. .... .._... C, R�?, , mb � �.. �� (Printed Name of Person Signing) V ACCEPTANCE The above,bid is � aptd-dLt�hi$ Z day of .... ..... Subject to thofolio i hditio .m Gary A. Gilot, President Elizabeth A. Maradik, Member Joseph R. Molnar, Member Jordan V. Gathers, Member Therese J. Dorau, Member Attest: Linda M. Martin, Clerk Version 4/2/2019 Contractor's Bid for Public Works - 2 20 PART 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/her/its bid. Attach additional pages for each section as needed. SECTION I EXPERIENCE QUESTIONNAIRE 1. Attach information regarding projects your organization has completed for the period of one (1) year prior to the date of the current bid. 2. Attach a listing of public works projects currently in process of construction by your organization. 3. Attach information regarding any failure to complete any work awarded to you and the location thereof. 4. Attach references from private firms for which you have performed work. SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE 1. Attach an explanation of your plan or layout for performing proposed work. (Examples could include a narrative of when you could begin work, complete the project, number of workers, etc. and any other information which you believe would enable the City of South Bend to consider your bid.) 2. Attach a listing of the names and addresses of all subcontractors (i.e. persons or firms outside your own firm who have performed part of the work) that you have used on public works projects during the past five (5) years along with a brief description of the work done by each subcontractor. 3. If you intend to sublet any portion of the work, attach the name and address of each subcontractor, equipment to be used by the subcontractor, and whether you will require a bond. However, if you are unable to currently provide a listing, please understand a listing must be provided prior to contract approval. Until the completion of the proposed project, you are under a continuing obligation to immediately notify the City of South Bend in the event that you subsequently determine that you will use a subcontractor on the proposed project. 4. Attach a listing of equipment you have available to use for the proposed project. 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 4/2/2019 Contractor's Bid for Public Works - 3 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 Indiana ...... ) SS: _St., J_ose,h..., COUNTY ) The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury that: 1. Contractor has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and 2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency; and 3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investment activities in Iran. a. For purposes of this Certification, "Iran" means the government of Iran and any agency or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from time -to -time. b. As provided by Ind. Code § 5-22-16.5-8, 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 4/2/2019 Contractor's Bid for Public Works - 4 4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the Contractor subsequently learns is an unauthorized alien. Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of Contractor's newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3. Contractor's documentation of enrollment and participation in the E-Verify Program is included and attached as part of this bid/quote; and 5. Contractor shall require his/her/its subcontractors performing work under this public contract to certify that the subcontractors do not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the subcontractor subsequently learns is an unauthorized alien, and that the subcontractor has enrolled in and is participating in the E-Verify Program. The Contractor agrees to maintain this certification throughout the term of the contract with the City of South Bend, and understands that the City may terminate the contract for default if the Contractor fails to cure a breach of this provision no later than thirty (30) days after being notified by the City. 6. Persons, 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 may consider the Contractor's good faith efforts to obtain participation by those Contractors 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. In no event shall persons or entities seeking the award of a City contract be required to award a subcontract to an MBE/WBE; however, it may not unlawfully discriminate against said WBE/MBE. A finding of a discriminatory practice by the City's MBE/WBE Utilization Board shall prohibit that person or entity 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 for which the discriminatory practice or noncompliance pertains. 7. The undersigned contractor agrees that the following nondiscrimination commitment shall be made a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its agencies, boards or commissions. Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the performance of this contract with privileges of employment, or any matter directly or indirectly related to employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation, handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of contract. I, the undersigned bidder or agent as contractor on a public works project, understand my statutory obligations to the use of steel products or foundry products made in the United States (I.C. 5-16-8-1). I hereby certify that I and all subcontractors employed by me for this project will use steel products or foundry products made in the United States on this project if awarded. I understand I have an affirmative duty to notify the City in my bid that my proposal does not include the use of steel products or foundry products made in the United States. I understand it is my sole obligation and responsibility to provide a justification to the City, subject to review and approval, why the cost of United States made steel or foundry products is unreasonable. Prior to award and upon submission of bid which does not use steel products or foundry products made in the United States, the City, through its director of public works, shall make a determination if the price of United States made steel or foundry is unreasonable. I understand that violations hereunder Version 4/2/2019 Contractor's Bid for Public Works - 5 may result in forfeiture of contractual payments. I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for public works are true and correct. Dated this 11,.th day of AUS.................1 2020 Inc. of Contractor/Bidder or Its Agent �� Dustin Hilary VP of South Bend Area Printed Name and Title Subscribed and sworn to before me this 11ah....... day of u5ust.. , 20 20 M Commission Expires 6/5/22 Y.. .; ...:.:.. Notary Public Alifpza Krueger mN County of Residence St. Joseph 4C 4 H KRI.iEGER �r Contractor's Bid for Public Works - 6 ,iVtf lift�f ,} pubVic, state of {nJixna� �F �. -a e k .ICtSB�'Yt�:aUkiTW F .pir �,y Crymrriis rJrt s�s d Version 4/2/2019 -1, vtl BID/PROPOSAL011 it CITY OF SOUTH BEND ` Project Name: Speed Hump Installation Bid , 186 , ................ ---- ..... ....— — ---------------------- _ „ . ........ . Project Number: 120-043 ---- .--- _ ----------- _____ ....................................................................._. For Bids Due: August 11, 2020 at 9 30am Local Time — see III w :uitlll�ullllt�m�:� d:u)Ma� t!g4E for electronic bid submission information Contractor Name: Walsh & Kell, Inc. DIVISION A — Harter Heights Item No Description Quantity Unit Unit Price Total Amount 1 Speed Hump, Concrete 7 Each $19,450.00 $136,150.00 2 W 17-1 14 Each $201.00 $2,814.00 3 High Contrast Chevron Pavement 14 Each Markin Set ................... _ $.., .. e... 750 00 $10,500.00 Asa ..w.. DIVISION A TOTAL $149,464.00 DIVISION B — Monroe Park Item No Description Quantity Unit Unit Price Total Amount 1 Speed Hump, Concrete 4 Each $20,860.00 $83,440.00 2 W 17-1 8 Each 3 High Contrast Chevron Pavement 8 Each MarkinSet g ,,,,,,,( ,, $750.00 6 000.00 ------- DIVISION B TOTAL $91 ,048.00 DIVISION C — Riverside and Lathrop Item No. _ Description Quantity Unit Unit Price ...... ........ .-.-..._., Total Amount ...... ........ . 1 Speed Hump, Concrete .... --- _,,,,, 2 Each $19,400.00 $38,800.00 2 W 1.7 1_ _..... ............. �� .. 4 Each_201.00 ... __._.. $804 00...... 3 Contrast Chevron Pavement 4 Each Mark nr Set $750 00 $3,000.00 DIVISION C TOTAL $42,604.00 ........................................ _................. _............ --- Bidder (Firm): Walsh...-& Kelly_., -_Inc-_______ ......... ___..-__ Address: 24358 SR 23 City/State/zip: South Bend IN 46614 Telephone NumberBy , Dustin Hi (Signature) VP of South Bend Area (Printed Name of Person Signing) Version 4/2/2019 Contractor's Bid for Public Works - 7 umIM&co ✓�,0 C ti w moo o .................. 0 xlp'b m co bra st Q 0 O ,� N o a 00 r ._ r o a m R O — CL C w L ''cc V C m O W w m 0 t Q 'oo O IL U CD O �w Cc w am rl- rn 0 N c LU N Ln 2 O O :. � CV...... .. ......... .. _ .................. _ w th V � ~ 0 0 U v� a" m CL w L m w p O O Eco p -a o O c w V N r E � a ca Y j C in M y I Z O din 3 c 00 N CD pwQ i •� 0c g fig oo T � ~- mwC7 Oa, O �a CO E cc 0 2 y a w V = 0 o L: c'�o d HW� m: HOC 0 3 y w E E CD Q N 0-6o c OZZ rn�nw �a c o�g Q > ti7a 0m0 2w Om w'� 0c m V t� m :° o _06 -0_D O m 0 .................... ,,,.. .................... Z Q ++ R 10 cu Z c Z o E c -. O N C O a aL Mnr NN Ecu O Z m c 3 ca H� r+ 3 U U C (N r [V N L. 'O N z E m 01 _ E E Z U (6 I Y N = co otS 6 CD M 0 L C U as 00 CA .Fu sd w Emti L U > CD cn C/) BO G L O 0 N o w � U H - y N L -0 ;� M O to O O Z `� .0 � 0 d 'C - E � Q La � d � O (� cn E=� z U Z LcQ O 0s� N ` E C.) (n co) �+ d CD -0 O EEO X r 0 c cv 2 lLi c A c a m ILLY r cn�-1 N OJ 2 E ca cz N a co w 0 U a 0 v m N 0 U w c 0 U rn 0 N N c U m rs'^°A'nYa�wzro CITY OF SOUTH BEND' mama ,r" dry MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY DEVELOPMENT PROGRAM..,y.r 1 FORM MWBE-2.0 K 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 ("IDOA"). Project Number: 120-043 Date: 8/11 /20 Project Name: Speed Hump Installation Bid Bidder: Walsh &...Kelly Inc. Contact Person: Dustin _Hllal _ Telephone: 574 288-4811 Address: 24358 SR 23 State: Indiana zip: 4614 City: _a out 6 Bend ..... .... ... .... ...............__.._ Email: dustinh�walshkell.com To determine whether a bidder has demonstrated good faith efforts to reach the MBENVBE utilization goals g g s set forth in the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or commissions, REQUIRE ALL of the following Good Faith Efforts as listed in the table below*: .. ............---- ......... EVIDENCE OF GOOD FAITH EFFORTS ........................... ..------...................................................... ...... ...- -- . MBE/WBE 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 (ADVERTISE/CONTACT): ....... ....--- ---.------------_..-.-._.. -- --- ®, ...... In order for your bid to be deemed responsive, the City of South Be , uires that all perspective bidders complete no less than 2 of the following: 1.Attend all pre -bid meetings scheduled by the City to inform MBENVBEs of contracting and °"" subcontracting opportunities. 2. Advertise in general circulation and/or trade association publications concerning subcontracting opportunities, and allow MBENVBEs reasonable time to respond. it 37 Perform any and all necessary steps to provide written notice in a manner reasonably calculated to inform MBENVBEs of subcontracting opportunities and allowed sufficient time for them to participate effectively. 4. Utilize pre-existing services of available community organizations, small and/or disadvantaged business assistance offices and other organizations that provided assistance in the recruitment and placement of MBENVBE firms. **Bidder must circle or otherwise notate which of the two (2) required actions were performed. .........-------- GOOD FAITH NEGOTIATIONS. The bidder negotiated in good faith with interested MBENVBEs, including providing such MBENVBE's with adequate information about the plans, specifications and other . requirements of the subcontract and did not reject MBENVBEs as unqualified without sound business reasons based on a thorough investigation of their capabilities. �. MBE/WBEONToRAC{biddero increase hekel hood of meeting the MBENUBE goals ( , SMALL work to be performed by including breaking down contracts into smaller units to facilitate MBENVBE participation) J'(C on the T RECORDS: - h ._. ---........... CONTRA The bidder has maintained the following records for each MBENVBE that has subcontracting opportunity: ." 1. Name, address, and telephone number; 2. A description of information provided by the bidder or subcontractor; and 3. A statement of whether an agreement was reached, and if not, why not, including any reasons for concluding that the MBENVBE was unqualified to perform the job. --._ ....... . --- - -- ----- -.-.-. ....... -- *Proper demonstration of Good Faith Effort requires your initials next to all of the above boxes. Any omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of South Bend reserves the right to request additional information. Version 4/2/2019 Contractor's Bid for Public Works - 9 , CITY OF SOUTH BEND �g OUT, ;,-�- MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY r14 P � 1 DEVELOPMENT PROGRAM FORM MWBE-2.1r"' MBE/WBE CONTACTED This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring contacted MBE/WBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business. PAGE I OF Project Number: 120 043 MBE/WBE Participation Goal Project Name: ,,,-,)Speed Hump Installation Bid Bidder: By: h & Keller Inc. ry (Title) E/WBE Firm Traffic Control Specialists, Inc. Owner or Contact at MBE/WBE Firm Tracey J. Triska Telephone: 574-772-7001 Fax: 574-772-7002 TYPE OF WORK SOLICITED FOR THIS PROJECT: Signs & Chevron Pavement Markings RESULTS OF CONTACT WITH THE MBE/WBE FIRM: (Date) Email: estimating@tcspeciallsts.net .............. If Walsh & Kelly Inc is awarded the pro. ct, we_ll subcontract Traffic Control Specialists, Inc. for their work. MBE/WBE Firm Slusser's Green Thumb, Inc. .,. . ......... ..... -- Owner or Contact at MBENVBE Firm John Williamson Telephone: 574-722-3102 Fax: 574-722-2993 Email: info@slussers.com . __...... .- TYPE OF WORK SOLICITED FOR THIS PROJECT; Sodding RESULTS OF CONTACT WITH THE MBE/WBE FIRM: If Walsh &Kell..., Inc. is awarded the prole— we'll subcontract Slusser's Green Thumb, _Inc for their work. Version 4/2/2019 Contractor's Bid for Public Works - 10 Surety O + 908.903.3485 202B Halls Mill Road, PO Box 1650 F + 908.903.3656 Whitehouse Station, kU 088894650 Federal Insurance Company AIA Document A310TM - 2010 Bid Bond Any singular reference to Contractor, Surety, Owner or other party shall be considered plural where applicable. CONTRACTOR SURETY (Name, Iegal status and address): (Name, Iegaistatus and principal place of business): Walsh & Kelly, Inc. Federal Insurance Company 24358 State Road 23 202B Halls Mill Rd., PO Box 1650 South Bend, IN 46614 OWNER Whitehouse Station, NJ 08889-1650 (Name, legal status and address): City of South Bend, Indiana 227 West Jefferson Boulevard South Bend, IN 46601 BOND AMOUNT 5% Five Percent of the Base Bid Plus any Alternates PROJECT (Name, location or address, and Project number, if any) Speed Hump Installation Bid, Project No. 120-043 The Contractor and Surety are bound to the Owner in the amount set forth above, for the payment of which the Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, as provided herein. The conditions of this Bond are such that if the Owner accepts the bid of the Contractor within the time specified in the bid documents, or within such time period as may be agreed to by the Owner and Contractor, and the Contractor either (1) enters into a contract with the Owner in accordance with the terms of such bid, and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a surety admitted in the jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof, or (2) pays to the Owner the difference, not to exceed the amount of this Bond, between the amount specified in said bid and such larger amount for which the Owner may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. The Surety hereby waives any notice of an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for an extension beyond sixty (60) days. If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor. Printed in cooperation with theAmerican Institute of Architects 6" by Chubb. The language in this document conforms to the language used in AIA Document A310R1r- 2010. Form 15.02-0575-M ptev.3117) 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 deemed deleted here from and provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein. When so furnished, the intent is that this Bond shall be construed as a statutory bond and not as a common law bond. Signed and sealed this 11 th (Witness) T Alisha Krueger (Witness) Kevin T. Parsley day of August, 2020 Walsh & Kell),, In (Title) Federal Insurance Company (Attorney -in -Fact) Lisa M. pp (o ore; lef Printed in cooperation with theAmerican institute of Architects (ALA) by Chubb. The language in this document conforms to the language used in AM DocumentA310 'rm-2010. Form OW2.0575•FED OW. 3117) 2 CHUBS" Power of Attorney Federal Insurance Company I Vigilant Insurance Company I Pacific Indemnity Company Westchester Fire Insurance Company I ACE American Insurance Company Know All by These Presents, that FEDERAL INSURANCE COMPANY, an Indiana corporation, VIGILANT INSURANCE COMPANY, a New York corporation, PACIFIC INDEMNITY COMPANY, a Wisconsin corporation, WESTCHESTER FIRE INSURANCE COMPANY and ACE AMERICAN INSURANCE COMPANY corporations of the Commonwealth of Pennsylvania, do each hereby constitute and appoint Lisa M. Parsley Surety Bond Number, Bid Bond Obligee: City of South Bend, Indiana each as their true and lawful Attorney -in -Fact to execute under such designation in their names and to affix their corporate seals to and deliver for and on their behalf as surety thereon or otherwise, bonds and undertakings and other writings obligatory in the nature thereof (other than bail bonds) given or executed in the course of business, and any instruments amending or altering the same, and consents to the modification or alteration of any instrument referred to in said bonds or obligations. In Witness Whereof said FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, PACIFIC INDEMNITY COMPANY, WESTCHESTER FIRE INSURANCE COMPANY and ACE AMERICAN INSURANCE COMPANY have each executed and attested these presents and affixed their corporate seals on this 1st day of November, 2019. Dawn M. Chloros, Assistant Secretary 11, Z�h STATE OF NEW JERSEY County of Hunterdon SS Stephen M. Haney, Vice President -:cam �� _ Wa f'; � On this le day of November, 2019, before in% a Notary Public of New Jersey, personally came Dawn M. Chloros and Stephen M. Haney, to me known to be Assistant Secretary and Vice President respectively, of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, PACIFIC INDEMNITY COMPANY, WESTCHESTER FIRE INSURANCE COMPANY and ACE AMERICAN INSURANCE COMPANY, the companies which executed the foregoing Power of Attorney, and the said Dawn M. Chloros and Stephen M. Haney, being by me duly sworn, severally and each for herself and himself did depose and say that they are Assistant Secretary and Vice President respectively, of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, PACIFIC INDEMNITY COMPANY, WESTCHESTER FIRE INSURANCE COMPANY and ACE AMERICAN INSURANCE COMPANY and know the corporate seats thereof; that the seals affixed to the foregoing Power of Attorney are such corporate seals and were thereto affixed by authority of said Companies; and that their signatures as such officers were duly affixed and subscribed by like authority. Notarial Seal MrmWuNiz J. ADHAAR TART NOTARY PUBLIC OF NEW JERMY , ••ems Na 2316M PiIBLIC OonNtlplOrm July 1%2024 sluaryFWIe CERTIFICATION Resolutions adopted by the Boards of Directors of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY on August 30, 2016, WESTCHESTER FIRE INSURANCE COMPANY on December 11, 2006; and ACE AMERICAN INSURANCE COMPANY on March 20, 2009: 'ABSOLVED, that the following authorizations relate to the execution, for and on behalf of the Company, of bonds, underuddngs, reeognizances, contracts and other written commitments of the Company entered Into in the ordinary comae of business (each a"Wrhtea Commitment): (1) Each of the Chairman, the President and the Vice Presidents of the Company is hereby authorized to execute any Written Commitment for and on behalf of the Company, under the seal of the Company or othe wlse. (2) Each duly appointed attorney -in -fact of the Company is hereby authorized to execute any Written Commitment for and on behalf of the Company, under the seal of the Company or otherwise, to the extent that such action is authorized by the gram of powers provided for In such persores written appointment as such attorney -In -fact (3) Each of the Chairmen, the President and the Vice Presidents of the Company Is hereby authorized, for and on behalfoftheCompany, toappoint inwriting any person the attorney -In - fact of the Company with fug power and authority to execute, for and on behalf of the Company, under the seal of the Company or otherwise, such Written Commitments of the Company as may be specified in such written appointment which specification may be by general type or class of Written Commitments or by specification of one or more particular Written Comminnentx (4) Each of the Chairman, the President and the Vice Presidents of the Company is hereby authorized, for and an behalf of the Company, to delegate In writing to any other officer of the Company the authority to execute, for and on behalf of the Company, under the Company's seal or otherwise such Written Commitments of the Company as are specified in such written delegation, which specification may be by general type or class of Written Commitments or by specification ofone or more particular Written Commitments. (5) The signature of any officer or other person executing any Written Commitment or appointment or delegation pursuant to this Resolution, and the sal of the Company, may be affixed by facsimile on such Written Commitment or written appointment or delegation. FARTHER RESOLVED, that the foregoing Resolution shag not be deemed to bean exclusive statement of the powers and authority of officers, employees and other persons to act for and on behalf of the Company, and such Resolution shall not limit or otherwise affect the exercise of any such power or authority otherwise validly granted or vested.' I, Dawn M. Chloros, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, PACIFIC INDEMNITY COMPANY, WESTCHESTER FIRE INSURANCE COMPANY and ACE AMERICAN INSURANCE COMPANY (the "Companies) do hereby certify that (1) the foregoing Resolutions adopted by the Board of Directors of the Companies are true, correct and In full force and effect, @t) "#,regoing Power ofAttomey is true, correct and in frill force and effect '` .�t"° W ' "''" August 11, 2020. Given ttaiiyr,triy handed `seak of said Companies at Whitehouse Station, NJ, this 9 liv c �^ � Dawn M. Chloros, Assistant Secretary eF9 ......._.... ..—. .TRE-EAU - C-.l-.._-0—F _ .__ x •p++ IN'rIE YOU WISH TO VERIFY THE AVfHENTTCITYOFTHIS BOND ORNOTIFY US OF ANY OTHER MATTER, PLEASE CONTACT US AT: _, .� ^ Telophone uy 1903- 3493 Fax 0 1Y 03 3656 a mal smuret i r. rubbcom Comb_-------- ...,..._m. f......... .. .. ...... i' n J, Combined: G�PJV! le(rev.tt_iB) CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK RESPONSIBLE BIDDER CHECKLIST Project Name Speed Hump Installation Bid Project No. 120-043 For Bids Due August 11, 2020 at 9:30am Local Time Contractor Name: Walsh & Keller. Inc. 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 II acts as an application for pre -qualification. Submission of Section II 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 3151 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. Version 5/16/2019 General Conditions - 6 SUBMISSIONS:POST BID Post -bid submissions must be submitted in accordance with Section 6-64 of the Responsible Bidding Ordinance. The post -bid submission requirements are as follows: 1. All bidders shall collect, maintain, and provide upon request, a current written list that discloses the name, address, licensing status, and type of work for any subcontractor from whom the bidder has accepted a bid and/or intends to hire on any part of the public work project, including individuals performing work as independent contractors. 2. Each subcontractor„ whose portion of the project is estimated to be at least one -hundred fifty thousand dollars (150,000.00), shall be required to adhere to the requirements of Section I of the Responsible Bidder Ordinance as though it were bidding directly to the City, except that the subcontractor shall submit the required information (including the name, address, and type of work) to the successful bidder prior to the commencement of work. 3. Failure of a subcontractor to submit the required information shall not disqualify the successful bidder from performing work on the project and shall not constitute a contractual default and/or breach by the successful bidder. However, the City may withhold all payment otherwise due for work performed by a subcontractor, until the subcontractor submits the required information and the City approves such information. 4. The disclosure of a subcontractor list ("Disclosed Subcontractor(s)") to the City by a bidder shall not create any rights in the Disclosed ubcontractor(s). Thus, a bidder may substitute another subcontractor for a Disclosed Subcontractor by giving the City, upon request, written notice of the name, address, licensing status, and type of work of the substitute subcontractor. 5. The successful bidder and all subcontractors on a public works project are required to submit certified payroll utilizing the federal form known as H-347 or a similar form on a bi-weekly basis„ submitted within 10 days after the end of each bi-weekly payroll period. Certified payrolls shall identify the job title and craft for each employee. Certified payrolls shall be submitted electronically. PleaseNote: Submissions deemed inadequate, incomplete, or untimely by the City may result in the automatic disqualification of the bid. The City, after review of complete and timely submissions, shall, in its sole discretion, after taking into account all information in the submission requirements, determine whether a bidder is responsive and responsible, and provide aFire-Qualification Verification Letter. The City specifically reserves the right to utilize all information provided in the contractor's submission and any information obtained by the City through its own independent verification of the information provided by the contractor. Version 5/16/2019 General Conditions - 7 PRE -QUALIFIED BIDDER CHECKLIST (a) Acknowledgements: (i) X By checking this box, I hereby acknowledge that I am a pre -qualified bidder with the City of South Bend and that I have met the pre -qualification requirements within the last twelve (12) months. A copy of my Pre -Qualification verification letter is attached. (ii) X By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided by me, and may also conduct random inquiries of my current and prior customers. (b) Attachments: (i) X Indiana Secretary of State's on-line records (ie. Business verification) dated within sixty (60) days of the submission of said document showing that business is in existence, current with the Indiana Secretary of State's Business Entity Report, and eligible for a certificate of good standing. (Not applicable to individuals, sole proprietors or partnerships). (ii) X Statement on staffing capabilities, including labor sources. This statement indicates and ensures I have sufficient employees on staff to complete the work. It outlines how I intend to meet the staffing needs of the work. (iii) X List of projects of similar size and scope of work performed in all areas, including the State of Indiana, within the last three (3) years. (iv) X For every project, submit evidence of participation in apprenticeship and training programs, applicable to the work to be performed on the project, which are approved by and registered with the United States Department of Labor's Office of Apprenticeship, or its successor organization. Version 5/16/2019 General Conditions - 8 PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED) (a) Acknowledgements: (i) _ By checking this box, I hereby acknowledge that I am not a pre -qualified bidder with the City of South Bend. (ii) By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided, and may also conduct random inquiries of my current and prior customers. The City reserved the right to utilize all information provided in this submission and all information obtained in inquiries or requests to determine if a bidder is responsive and responsible. Additionally, I acknowledge that all information provided to the City shall be regarded as public records. (iii) _ By checking this box, I hereby acknowledge that copies of all Applicable apprenticeship certificates or standards for training programs applicable to the work performed on the project may be requested at any time and shall be furnished upon request. (iv) By checking this box, I hereby acknowledge and ensure that I and all sub- contractors, from whom I have accepted a bid and/or intend to hire to perform work on the public work project, are properly licensed. Furthermore, I acknowledge my understanding that it is my responsibility to ensure that all sub -contractors have the necessary licenses to undertake the work called for in this bid. If a sub- contractor loses their license at any point, it is the responsibility of that sub- contractor to notify the City. (b) Attachments: (i) _ Indiana Secretary of State's on-line records (ie. Business verification) dated within sixty (60) days of the submission of said document showing that business is in existence, current with the Indiana Secretary of State's Business Entity Report, and eligible for a certificate of good standing. (Not applicable to individuals, sole proprietors or partnerships). List identifying all former business names. Any determinations by a court or governmental agency any violations of federal state, or local laws including, but not limited to, violations of contracting or antitrust laws, tax or licensing laws, environmental laws, Occupational Safety and Health Act (OSHA), or federal Davis -Bacon and related Acts, within the preceding five (5) years. (iv) _ Statement about staffing capabilities, including labor sources. This statement indicates and ensures I have sufficient employees on staff to complete the work I am bidding on OR outlines how I intend to meet the staffing needs of the work. (v) _ Statement that individuals who will perform work on the public work project on my behalf will be properly classified as an employee or as an independent contractor under all applicable state and federal laws and local ordinances. (vi) _ For every project, submit evidence of participation in apprenticeship and training programs, applicable to the work to be performed on the project, which are approved by and registered with the United States Department of Labor's Office of Apprenticeship, or its successor organization. (vii) _ Copy of a written plan for employee drug testing that covers all of my employees who will perform work on the public work project and meets or exceeds the requirements set forth in IC 4-13-18-5 or IC 4-13-18-6. (viii) _ Evidence that I am utilizing a surety company which is on the Bureau of Fiscal Service "Department of Treasury's Listing of Approved Sureties" as required in the bid specifications or contract. Version 5/16/2019 General Conditions - 9 (ix) _ Written statement of any federal, state or local tax liens or tax delinquencies owed to any federal, state or local taxing body in the preceding three years. (i) _ List of projects of similar size and scope of work performed in all areas, including the State of Indiana, within three (3) years prior to the date on which the bid is due. t (runt Name riere) Walsh & Kelly, Inc. (Name of Company) 24358 SR 23 (Address of Company) South Bend ................._.................. (City) Indiana (State) 574-288-4811 (Telephone Number) Version 5/16/2019 General Conditions - 10 Responsible Bidding Practices and Submission Requirements for Pre -Qualified Bidder Checklist (b) Attachments (i) Attached (ii) Staffing Capabilities: Walsh & Kelly, Inc. is signatory with the following unions which supply our workforce — Laborers International Union, Teamsters, Operating Engineers and Cement Masons. (iii) See Forms 96 and 96a (iv) All individuals who will perform worn on the public works project on behalf of Walsh & Kelly, Inc. will be properly classified under applicable state and federal laws and local ordinances. B Du,�� _-�ilarv, NIP of South Bend Area Dated:,, __August l l w 2020 Y;....� .. .,.�. �-�........ �......_..... FE. . . . . . (1) C 0 T ["J", jl�'� L ili I�IRYTI 1 6, Y R B ill z',V P LJI B)f I C mom W, M. =...40 one Q RE: Pre -Qualification Verification Dear Mr. Hilary; 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) 235-9251. Sincerely, Linda M. Martin, Clerk Part of State Form52414 (R2 / 2-13) Form 96 (Revised 2013) BID OF Walsh & Kell.Inc. (Contractor) . ..... 23 - ---- (Address) South Bend IN 46614 FOR PUBLIC WORKS PROJECTS OF City of South Bend Indiana Speed Hump Installation Bid Project No. 120-043 Filed ,August, 11th 2020 Action taken State Form 52414 (R 19-10) Prescribed by State Board of A counts - __ Form No. 96 Revised 2013', CONTRACTOR'S BID FOR PUBLIC WORK — FORM 96 PART 1 (To be completed for all bids. Please type or print) 1. Governmental Unit (Owner): 2. County: 3. Bidder (Firm): Address: City/State: 4. Telephone Number: 5. Agent of Bidder (If applicable): Date (month, day, year): _ flu LA St 11thw 2020, Cityof South,Bend, Indiana ... ... .... ....... __.. St. Joseph & Ke11, Inc,______ Walsh ......, --- ......... 24358 SR 23 South Bend, IN 46614......... (574) 2„88-4811 Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the public works project of City of South Bend, Indiana (Governmental Unit) in accordance with plans and specifications prepared by City of South Bend Indinaa — Dept. of Publc Works.- En�ineerin b Division and dated July 14t 20200 for the sum of See Attached $ See Attached. The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the notice. Any addendums attached will be specifically referenced at the applicable page. If additional units of material included in the contract are needed, the cost of units must be the same as that shown in the original contract if accepted by the Governmental Unit. If the bid is to be awarded on a unit basis, the itemization of the units shall be shown on a separate attachment. The Contractor and his subcontractors, if any, shall not discriminate against or intimidate any employee, or applicant for employment, to be employed in the performance of this contract, with respect to any matter directly or indirectly related to employment because of race, religion, color, sex, national origin or ancestry. Breach of this covenant may be regarded as a material breach of the contract. CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS (If applicable) I, the undersigned bidder or agent as a contractor on a public works project, understand my statutory obligation to use steel products made in the United States. I.C. 5-16-8-2. I hereby certify I and all subcontractors employed by me for this project will use U.S. steel products on this project if awarded. I understand that violations hereunder may result in forfeiture of contractual payments. ACCEPTANCE The above bid is accepted this m day of subject to the following conditions: Contracting Authority Members: PART II (For projects of $150,000 or more — IC 36-1-12-4) Governmental Unit: City of South Bend, Indiana Bidder (Firm): Walsh & Kelly, Inc. Date(month, day, year), August _1_ 1, 2020 These statements to be submitted under oath by each bidder with and as part of his bid. Attach additional pages for each section as needed. SECTION I EXPERIENCE QUESTIONNAIRE 1. What public works projects has your organization completed for the period of one (1) year prior to the date of the current bid? Contract Amount Class of Work When Completed .. Name and Address of Owner ........ $ 12,170,428 Reconstruction May 2019 Walsh Construction $ 5,489,454 Resurface November 2019 Lake County Hwy De pt $ 4 356,212 Resurface 2019 December..._ Cilyy of Crown Point ................_ $ ...._ 3,180,214 Resurface December 2019 St. Joseph County Hwy ....... ........ ._ ...................____ ...................... - Del t....._............ ._ .......................... ..... 3. What public works projects are now in process of construction by your organization? CONTRACT AMT CLASS OF WORK WHEN TO BE NAME AND ADDRESS COMPLETED OF OWNER 64,740 ...................... Resurface .. rrr,.m.. ......... ......._.�.......... May 2020 __ INDOT ....... ....._..... �......�. $.. 5,902,953 _.. Reconstruction_ June 2020 ...................M.................. INDOT ... 2,473,069 Reconstruction ........................... .. November _embe2020 INDOT $ 4,090,509 Resurface July 2020��— South Bend Regional ...... . — — _ ......... ...._........ .. Air ort...... .......r.. ........ 4. Have you ever failed to complete any work awarded to you? No If so, where and why? 5. List references from private firms for which you have performed work. Gatlin Plumbins �: & Heating Inc. 11„11 E. Main St., Griffith, IN...._Ms Clara, Muc1 — __ , Gough, Inc. 2200 E 88t" Dr Merrillville, IN 46410, Mr. Ray,!ppnd Gough _ Deer Construction Co,. 171,,E Sheffield Avenue__.yer, IN Janet Furman __ Grimme. 11 PLAN AND EQUIPMENT QUESTIONNAIRE 1. Explain your plan or layout for performing proposed work. (Examples could include a narrative of when you could begin work, completed the project, number of workers, etc. and any other information which you believe would enable the governmental unit consider your bid.) As required by owner 2. Please list the names and addresses of all subcontractors (i.e. persons or firms outside your own firm who have performed part of the work) that you have used on public works projects during the past five (5) years along with a brief description of the work done by each subcontractor. See Attached List 3. If you intend to sublet any portion of the work, state the name and address of each subcontractor, equipment to be used by the subcontractor, and whether you will require a bond. However, if you are unable to currently provide a listing, please understand a listing must be provided prior to contract approval. Until the completion of the proposed project, you are under a continuing obligation to immediately notify the governmental unit in the event that you subsequently determine that you will use a subcontractor on the proposed project. Will supply upon award of contract QUANTITY _. ITEM DESCRIPTION, CONDITION Y... EARS __....._.. - - PRESENT LOCATION SIZE, CAPACITY, OF ETC. ...... . ._ ...... SERVICE- ._ _ 5 Asphalt Plants Various Good Griffith, South Bend, Valparaiso, Lowell, LaPorte 19 Asphalt Pavers Various Good South Bend Grlffith,mIT m,r 4 Slipform Conc. Paver Various Good _ _..------- Griffith South a ..... Bend _. 3 Road Widener - -. Various — - Good -- ......... Griffith, South Bend .......�.. .._... _....... 5 _... — Motor Graders CAT/J.D, _._. Good --- - ......... Griffith, South Bend 56 _____-._ ......... Rollers ................1 Various Good _ Griffith, South Bend — - 36-.-.. Rubber Tire Loaders ..... - Various Good Griffith, South Bend 18 Excavators Various Good —....__ Griffith, South Bend ...._............ m__ ... _ _ 9 _ ..... Bulldozers ��,,.,,,, Various Good _ Griffith, South Bend 7 ...... _....... Low Bo Tractors ---..... Various Good Griffith, South Bend 9 Flatbed Dum ads — Various... ....... Good..... — - __..... i . South Bend Gnffith,..........�....M.... .... ....... 54 ........ .....�,,. /z and /ton Pickups ........ Various Good Griffith,Gn rt South vend 78 Trucks 1 Ton Crew Trucks ... ......... Various Good Griffith South Bend m .. ...... _ 3 _ Cold Planers ....._....___ Wirtgen 1900 Good Griffith, South Bend DC 72 Tn Axle Dum Mack Good Griffith, South Bend 4. What equipment do you have available ---- to use for the proposed project? Any equipment to be used by subcontractors may also be required to be listed by the governmental unit. 5. Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing your proposal? Otherwise, please explain the rationale used which would corroborate the prices listed. Yes, we received quotes from potential subcontractors and suppliers 4 SECTION III CONTRACTOR'S FINANCIAL STATEMENT Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial statement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to the governing body awarding the contract must be specific enough in detail so that said governing body can make a proper determination of the bidder's capability for completing the project if awarded. SECTION IV CONTRACTOR'S NON -COLLUSION AFFIDAVIT The undersigned bidder or agent, being duly sworn on oath, says that he has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. He further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale SECTION V OATH AND AFFIRMATION I HEREBY AFFIRM. I1NDE:R. THE PENA.L'I"IES FORPERJURY IHAT THE FACITS AND INFORMATION coN':I".AINED IT411. 1E 1701 I;',GOINC RID FOR P . I.,K, 'O:... S .A.RE ":I7EI UE AND CORRECT. Dated. at, ........ Sera, t.h. en .. this �ill, day of t, � (Nam.e (Title of Person Signing) ACKNOWLEDGEMENT STATE OF Indiana ) ss COUNTY OF St.° Joseh Before me, a Notary Public, personally appeared the above -named _ Dustin-Hila;11` and swore that the statements contained in the foregoing document are true and correct. Subscribed and sworn to before me this ,.__ tI!h............... .......... day of — Au gst, 2020, My Commission Expires: June 5. 2022 County of Residence: St. Joseph y 4 "sha Krueger, Notary P ` lic F 0n n r,�rmar �.� R �6'lllltttt pp,�r'�m e�.i Y 6SH Public. ",a'iSiB ol lnd6 NOWY p stAL,- My (,Orfl 11&S{O F.r iris 1 Form 96 Section II, #2 Subcontractors Used on Public Works Contracts Durina the Past 5 Years SUBCONTRACTORS COMPANY SEWER B & D Sewer Deboer Egolf Delta III Dyer Construction Gatlin Plumbing & Heating Gough, Inc. Grimmer Construction Hasse Construction HRP Construction Rex Construction Wirtz & Yates, Inc. Woodruff & Sons MILLING C.E. Hughes Milling, Inc. Javelina Construction, Inc. Mid America Milling Co. McCrite Milling Specialties Company ELECTRICAL INSTALLATION Hawk Enterprises Midwestern Electric S/T Bancroft Electric Sweney Electric Company Trans Tech Electric SIGN INSTALLATION Hawk Enterprises Midwestern Electric RoadSafe Traffic Systems State Barricading, Inc. Traffic Control Specialists, Inc. PAVEMENT MARKINGS The Airmarking Company Blackout Sealcoating RoadSafe Traffic Systems State Barricading, Inc. Traffic Control Specialists, Inc. Traffic Management Company TRAFFIC CONTROL RoadSafe Traffic Systems Traffic Control Specialists, Inc. Traffic Management Company LANDSCAPE Great American Landscape Hubinger Landscape Slusser's Green Thumb, Inc ADDRESS 531 Winston Ct 5772 Melton Road 2063 W 1250 S 1716 Sheffield Avenue 1111 E. Main Street 2200 E. 88th Drive 2619 Main Street 10 Lincoln Avenue 5777 Cleveland Rd. 700 Schiller Avenue P.O. Box 41 P.O. Box 450 CITY/STATE/ZIP Schererville, IN 46375 Portage, IN 46368 Hanna, IN 46340 Dyer, IN 46311 Griffith, IN 46319 Merrillville, IN 46410 Highland, IN 46322 Calumet City, IL 60409 South Bend, IN 46624 Schererville, IN 46375 Kentland, IN 47951 Michigan City, IN 46361 PHONE (219) 322-2300 (219) 763-9700 (219) 797-4004 (219) 865-2961 (219) 924-6972 (219) 756-2200 (219) 924-1623 (219 )932-1611 (574)271-7800 (219)322-8090 (219) 474-6542 (219) 872-8605 FAX (219) 865-0065 (219) 763-9703 (219) 797-3008 (219) 865-2963 (219) 924-1401 (219) 756-2202 (219) 924-0328 (219)932-6829 (574)271-0524 (219) 322-0031 19) 8795339 3113 Holmans Lane Jeffersonville, IN 47130 (812) 725-8665 (812) 725-8672 13476 Britton Park Rd. Fishers, IN 46038 (317) 841-8364 (317) 841-0075 6200 W. Hwy 62, Ste 400 Jeffersonville, IN 47130 (812) 282-2751 (812) 283-9846 209 Quality Ave. Ste 9 New Albany, IN 47150 (812) 941-0252 (812) 941-0852 9350 E. 30th St. Indianapolis, IN 46229 (317) 594-0291 (317) 594-0271 1850 E. North St 1620 E. Chicago Ave 25020 State Road 2 9111 Louisiana St. 4601 Cleveland Road 1850 E. North St 1620 E. Chicago Ave 3122 Olympia Dr 24963 U.S. Highway 20 1810 W Pacific Avenue P.O. Box 526 7440 W. 87th Place 3122 Olympia Dr 24963 U.S. Highway 20 1810 W Pacific Avenue 3542 Highwav Avenue 3122 Olympia Dr 1810 W Pacific Avenue 3542 Hiahwav Avenue P.O. Box 235 210 E. 113th Avenue 125 Montgomery Street Crown Point, IN 46307 East Chicago, IN 46312 South Bend, IN 46619 Merrillville, IN 46410 South Bend, IN 46619 Crown Point, IN 46307 East Chicago, IN 46312 Lafayette, IN 47909 South Bend, IN 46628 Knox, IN 46534 Rochester, IN 46975 Bridgview, IL 60455 Lafayette, IN 47909 South Bend, IN 46628 Knox, IN 46534 Hiahland. IN 46322 Lafayette, IN 47909 Knox, IN 46534 Highland, IN 46322 Dyer, IN 46311 Crown Point, IN 46307 Logansport, IN 46947 (219) 662-8090 (219) 397-4444 (574) 287-6490 (219) 769-6007 (574) 272-9673 (219) 662-8090 (219) 397-4444 (317) 780-1825 (574) 287-2078 (574) 772-7001 (574) 223-5817 (219) 864-2300 (317) 780-1825 (574) 287-2078 (574)772-7001 (291) 746-2433 (317) 780-1825 (574)772-7001 (219) 746-2433 (219) 322-7033 (219) 662-9911 (574)722-3102 (219) 662-8093 (219) 397-8888 (219) 769-0565 (574)271-0144 (219) 662-8093 (219) 397-8888 574)772-7002 (574)223-7959 (708) 430-6910 (574) 772-7002 (574)772-7002 (219) 322-4419 (219) 662-6206 (574) 722-1628 T & J Landscape Service GUARDRAIL/FENCING Acorn Fence C Tech Corporation James H. Drew Company Security Industries Specialties Company TRUCKING/HAULING mm ..-....._..�..... ........_--- C. Lee Construction Services Condon Trucking, LLC Fanio Services Gilmer Trucking Material Transfer Inc. Morris Motor Service, Inc. P & C Trucking Superior Construction Co., Inc. V & R Trucking, Inc. SRPM'S & S Markers, Inc. UNDERSEAL--- .............. Rieth-Riley-Construction Co., Inc. TREE REMOVAL Dave's Tree Service Homer Tree Service Timber Masters LLC ....-LIME STABILIZ�.. Tpp.........wwwu A ION ...-.... .... Mt. Carmel Sand &Gravel Rock Solid Stabilization Specialties Company PIPE LINING Indiana Reline, Inc. SAW.... CUTT.I..N.G........... Diamond Coring Co., Inc. Quality Saw & Seal, Inc. SEAL COATING/STRIPING Site Services, Inc. Blackout Sealcoating _ UNDERDRAIN 3D Company, Inc. 8253 Wicker Avenue 2041 164th Street 5300 W.100 North 8701 Zionsville Rd. 1000 Georgiana St 9350 E. 30th St. 1011 S. Lake St 18245 Amberley Ln 28015 SR 23 20390 New Road 7811 West 101 st Ave. 10525 W US Hwy 30 Bld 7 4410 Ross Road 1455 Louis Sullivan Dr 1845 Elmer St. St. John, IN 46373 Hammond, IN 46320 Boggstown, IN 46110 Indianapolis, IN 46268 Hobart, IN 46342 Indianapolis, IN 46229 Gary, IN 46403 South Bend, IN 46637 North Liberty, IN 46554 South Bend, IN 46614 Crown Point, IN 46307 Wanatah, IN 46390 Gary, IN 46408 Portage, IN 46368 South Bend, IN 46628 2189 IN600 W Thorntown, IN 46071 2454 West CR 450 North LaPorte, IN 46350 1555 Park West Circle 14000 S. Archer Ave P.O. Box 245 1611 College Dr. 5104 Mann Drive 9350 E. 30th St. 312 E. Main Street 11800 S Ewing Ave 7600 W. 79th Street 10117 Kennedy Ave 7440 W. 87th Place 3200 East CR 350 North Munster, IN 46321 Lockport, IL 60441 Dyer, IN 46311 Mt. Carmel, IL 62863 Ringwood, IL 60072 Indianapolis, IN 46229 Sulphur Springs, IN 47388 , IL 60617 9w, I L 60455 Highland, IN 46322 Bridgview, IL 60455 Muncie, IN 47303 219) 374-9900 (219) 374-9950 (219) 844-8400 (317) 835-2745 (317) 876-3739 (219) 942-9447 (317) 594-0291 (219) 888-9554 (574) 360-4326 (574) 233-3236 (574) 229-3233 (219) 865-9575 (219) 733-9430 (219) 972-0193 (219) 787-0850 (574) 329-2102 482-6184 (219) 362-6178 (219) 922-9829 (815) 838-0320 (219) 864-8733 (618) 262-5118 (815) 653-2585 (317) 594-0291 (219) 844-8441 (317) 835-2781 (317) 876-3829 (219) 942-9448 (317) 594-0271 (219) 888-9564 (574) 271-8984 482-6284 (219) 922-9843 19) 322-9391 (618) 263-4084 (815) 653-2583 (317) 594-0271 (765) 766-5040 (765) 533-5831 3) 978-5000 3) 767-9300 (219) 924-9944 (219) 864-2300 (708) 430-6910 (765) 288-3326 (765) 288-3344 7 The name of the partnership firm under which the above partners are operating is Give names and titles of all persons having authority to execute and receipt estimate vouchers and to conduct other business for the partnership, the signatures of whom are legally binding. The undersigned hereby declares that the foregoing is a true statement of the financial or corporation herein first named, as of the date herein first given; that this statement is for the , whom it is submitted to award the submittor a contract; and that any depository, vendor or outer to supply such party with any information necessary to verify this statement. NOTE: A co -partnership must give firm name and signatures of all partners. A corporation must give full corporate name, signature of official and affix corporate seal. of the individual, co -partnership 4se of inducing the party to A. -in named is hereby authorized th .BeW6d� sKoa t n ,Z% co Affidavit for Individual Z p STATE OF Wiz, a s _ �w COUNTY OF ss t _ being duly sworn, dcl.fso andys Skuatrfh foregoing fine, —.._..... - g g financial statement, taken from his books, is a true and accurate statement of financial condition as d'f he' t- thotarfin' that the answers to the foregoing interrogatories are true. '41,81111W (Applicant must sign here) Subscribed and sworn to before me this day of 20 Notary Public Affidavit for Co -Partnership STATE OF COUNTY OF { ss ........being duly sworn, deposes and says that he is a member of the firm of : that he is familiar with the books of the said firm showing its financial condition; that the foregoing financial statement, taken from the bo oks of the said fine , is a true and accurate statement of the financial condition of the said fine as of the date thereof and that the answers to the foregoing interrogatories are true. (Member of firm must sign here) Subscribed and sworn to before me this day of 20 Notary Public Affidavit for Corporation STATE OF Indiana { COUNTY OF St . Josss ei h Dustin Hilw-I .......- being duly sworn, deposes and says that he is,,,,,,President,_, of the Walsh &„.Kelp ._Inc._ ................. the corporation described in and which executed the foregoing statement; that he is familiar with the books,rfl?khe said corporation showing its financial condition; that the foregoing financial statement, taken from the books of the said corpoj,,-Ai�ti, is a true and accurate statement of the financial condition of said corporation as of the date thereof and that the answers to Ohte f(Agoirig iuit rr'ogatoi jcs are true. Subscribed and sworn to before me this 11 th Alisha l Oeger, Notary Public rriiuu A L ISHA K,F,UEG Notary PE.t hc. 5t�tw� o{ �,xfii�ri G %e. �y Coonty n EF�4_ r mot, jose�p z� of My t„firrilsoloatl C-=,r�'sfMB a 7 C9 (Offs t:.r -sign hc; tr) Dustin Hilary, VP of South Bend Area 15 State of Indiana Office of the Secretary of State CERTIFICATE OF EXISTENCE To Whom These Presents Come, Greeting: I, CONNIE LAWSON, Secretary of State of Indiana, do hereby certify that I am, by virtue of the laws of the State of Indiana, the custodian of the corporate records and the proper official to execute this certificate. I further certify that records of this office disclose that WALSH & KELLY INC duly filed the requisite documents to commence business activities under the laws of the State of Indiana on March 29, 1966, and was in existence or authorized to transact business in the State of Indiana on July 16, 2020. I further certify this Domestic For -Profit Corporation has filed its most recent report required by Indiana law with the Secretary of State, or is not yet required to file such report, and that no notice of withdrawal, dissolution, or expiration has been filed or taken place. All fees, taxes, interest, and penalties owed to Indiana by the domestic or foreign entity and collected by the Secretary of State have been paid. In Witness Whereof, I have caused to be affixed my signature and the seal of the State of Indiana, at the City of 1p°n ianr ,i;aoli,„ July 16, 202 19,V184 057 / 20201527226 All certificates should be vandat.ed here. lr�li ° dt9 Rl ^aar .sin.J;rev/ w ii l ntatwrMr iiww.t Expires on August 15, 2020. to provide CONSTRUCTION SERVICES for PUBLIC WORKS PROJECTS to thd STATE OF INDIANA II I I I I I i - let ME 14EM Raw IN Mr-r, IQ M a, UNIT 01 EWA 1.1.j q 19)4*"Jidaj LRwjj oluMNICUMNIM FMMUTHUM] ffaMfMT1 VITEIT44221 �.M ► � i V1411i 21 &T-11 101 11M Phone 219-924-5900 Fax 219-924-8768 Company Official VEVIV Y�ELLY — for the twenty-seven month period stated herein, unless revoked by this Board for cause, and in the classifications of services stated below. This certificate supercedes any previous certificate. 1611.01 Concrete Construction of Roads & Curbing 402 WEST WASHINGTON STREET, ROOM W467, INDIANAPOLIS, INDIANA 46204, ALSO ACTS AS THE OFFICIAL NOTICE OF EXPIRATION. Tracy L. Cross, Executive 9 retary Certification Board DAPW P02 State Form 3983R Rev. 07/06 WRITTEN CONSENT TO RESOLUTIONS of the BOARD OF DIRECTORS of WALSH & KELLY, INC. The undersigned, being all of the Directors of WALSH & KELLY, INC., an Indiana Corporation, hereby consent to the following actions to be taken by the Corporation without a meeting of the Board of Directors under the applicable provisions of the Indiana Business Corporation Law, as amended: RESOLVED that the following be, and hereby are, elected officers of the Corporation, to hold the office until the next regular meeting of the Board of Directors and until their successors are duly elected and have qualified: John M. Peisker, President Jeffrey L. Swan, Executive Vice President John P. Vercruysse, Executive Vice President Jamie L. Tancos, Vice President of Finance, Secretary & Treasurer Gregory A. Kelly, Vice President Charles Potts Jr., Vice President Albert E.VanDenBergh, Vice President David L. Franz, Vice President David J. Misirly, Vice President Gregory A. Hoffman, Vice President Dustin P. Hilary, Vice President Lynn J. Bauer, Vice President Mark E. Krachenfels, Vice President RESOLVED FURTHER that the actions of the Officers of the Corporation taken since the last meeting of the Board of Directors be, and the same hereby are, fully ratified and approved. RESOLVED FURTHER that the following be, and they hereby are, authorized to execute all contracts or similar documents on behalf of the Corporation: John M. Peisker, President Jeffrey L. Swan, Executive Vice President John P. Vercruysse, Executive Vice President Jamie L. Tancos, Vice President of Finance, Secretary & Treasurer Gregory A. Kelly, Vice President Charles Potts Jr., Vice President Albert E.VanDenBergh, Vice President David L. Franz, Vice President David J. Misirly, Vice President Gregory A. Hoffman, Vice President Dustin P. Hilary, Vice President Lynn J. Bauer; Vice President Mark E. Krachenfels, Vice President RESOLVED FURTHER that this consent shall be in lieu of an annual meeting of the Board of Directors of the Corporation and shall be filed in the minute book of the Corporation in place of any such annual minutes. <<SIGNATURES ON THE NEXT PAGE>> EXECUTED this 15`h day of January, 2020. Fred Fehre feld, Jr. Albert E. VanDenBergh Kevin J. Kelly e� ............ ...... ...... James % " Fehsenfeld 4 Jyn P. Vercruysse EXECUTED this 15"' day of January, 2020. Fred Fehsenfeld, Jr. James C. Fehsenfeld Albert E. VanDenBerg h John P. Vercruysse EXECUTED this 15th day of January, 2020. Fred Fehsenfeld, Jr. James C. Fehsenfeld Albert E. VanDenBergh John P. Vercraysse p , � s Kevin Kelly�'� Walsh 'u�l Ciii;`$III`r IV litrCl Yu i� Oi � IG ND lore in 7 r 3 19 W'N�i W"%wa,4s,h kuw'µgl�y.collrry 50 th ioi'"�W �� (Inc �i�a Q (9), 924, '��00 V�li'oan� I�, 40, dreldl ��CiC Yf Equal Employment Opportunity/Affirmative Action Policy Statement It is the policy of Walsh & Kelly to afford equal opportunity for employment to all individuals regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, housing status, or veterans' status. The corporation is committed to this policy by our status as a federally assisted government contractor. We are far more strongly bound to the policy by the fact that adherence to the principles involved is the only acceptable American way of life. Therefore, it is the policy of this corporation to assure that applicants are employed, and that employees are treated during employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, housing status, or veterans' status. Such action shall include: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship, pre -apprenticeship, and/or on-the-job training. The successful achievement of a nondiscriminatory employment program requires a maximum of cooperation between management and employees. In fulfilling its' part in this cooperative effort, management is obliged to lead the way by establishing and implementing affirmative procedures and practices which will ensure our objective, namely equitable employment opportunity for all. (Minority and female employees are encouraged to participate in all company activities and refer applicants.) Our company will take affirmative action to ensure that we will (1) recruit, hire and promote all job classifications without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, ancestry, disability, veterans status or housing status; (2) base decisions on employment so as to further the principle of equal employment opportunity; (3) ensure that promotion decisions are in accord with principles of equal employment opportunity by imposing only valid requirements for promotional opportunities; (4) ensure that all personnel actions such as compensation, benefits, transfers, layoffs, return from layoffs, company sponsored training, education, tuition assistance, social and recreation programs will be administered without regard to race, color, religion, sex, sexual orientation, gender identify, national origin, age, disability veterans status or housing status. I have designated Amy Wright, VP, HR and Talent Development, as the Equal Opportunity Officer to direct the establishment of and to monitor the implementation of personnel procedures to guide our affirmative action program. This official is charged with designing and implementing audit and reporting systems that will keep management informed on a regular basis of the status of equal employment opportunity and affirmative action. She can be reached at (317)616-4907. Employees will be made known of our commitment to equal employment through the following means: • Posting of equal opportunity notice on bulletin boards EQE M/F/Vets/Disabled � ��GRIFFITH r � �� Ilf �`'�° i( & 1700 East Main Street 24358 SR 23 Griffith, Indiana 46319 www.walshkelly.com South Bend, Indiana 46614 Phone (219) 924-5900 Phone ISM) 2 -4811 0fi i�1; �' a one, Fax (219) 924-8768 Fax (574) 289-7174 • Including our equal opportunity statement in our Handbook which is disseminated to all employees • Annual supervisory training Potential employees will be made aware of our policy through the following means: • By including the words "Equal Opportunity Employer" or EOE in all advertisements and notices for job openings Sending notices to union affiliations Posting of equal opportunity notice on all company and job site bulletin boards Except when precluded byvalid bargaining agreements, we will conduct systematic and direct recruitment through public and private referral sources likely to yield qualified female and minority group applicants. This recruitment will be conducted by direct and personal contacts with female and minority organizations in the project area. All union organizations with which we come into contact, including Laborers, Carpenters Operators, and Teamsters, will be made aware of, and provided copies of our plan. They will be informed of our desire for them to implement our program and will be specifically asked to refer females and minority group employees for employment. It is our policy that wages, working conditions and employee benefits will be determined and administered on a non-discriminatory basis. We will conduct periodic reviews of wage rates, employee benefits, and promotional capabilities to assure they are administered in a non-discriminatory manner. Supervision has been made to understand that their work performance is being evaluated based on their equal employment opportunity efforts and results, as well as other criteria. It shall be a responsibility of the supervision to take actions to prevent harassment of employees placed through affirmative action efforts. We shall comply with the Civic Rights Act of 1964, as amended, the Federal Highway Act of 1968, the Executive Order #11246 and #11375, the Rehabilitation Act of 1973, as amended, the Vietnam Era Veterans Readjustment Assistance Act of 1974, as amended, the Indiana Civil Rights Act and other applicable Federal and State Laws and regulations pertaining to equality of Opportunities and Affirmative Action policies. We have developed an Affirmative Action Program for Veterans and Individuals with Disabilities. p. _..................... ...... ...........__.. John1 Peisker, President, Walsh & Kelly ME M/F/Vets/Disabled J� .,........... .. ..._ ........ Date nl IttlO U V fi��ll � (IJ wA I! A� III Y UI III ��C � i,% �k�iV� LX Ill I I MUD Ul�'Y� U �� 'WIIIW'��d: '�IMVIY'wvC Owa �. 1,700E s[, �11'�11n SVI2M'�, 24 F5V iQ } s r A 1 Ike Ni ,�) a 4 63P9 ��°P�f�N ��pd� lUBm��V��w ��1�� u,Nb(r�� pia P1' P c G d �r4ana 46614 4tor lD kl J Y 1� P�rpi� P�Voon �°7�0✓� �YYa �fy9'Yr 00,00! Kiel,�� I�6��rr. I r��(V%r714 07'8 PM,l,°>r,P40 289-7l/1 DATE: April 13, 2020 TO: All Employees RE: EEO Officer Appointment Amy Wright, VP, HR and Talent Development, has been appointed Equal Employment Opportunity Officer for Walsh & Kelly. It is her responsibility to coordinate, advise and assist management and supervisors in their responsibilities of assuring all applicants and employees' equal opportunities in all aspects of their employment. She will review complaints that allege discrimination because of race, religion, color, sex, sexual orientation, gender identity, age, national origin, disability, housing status or veteran status. Employees of Walsh & Kelly are to submit any issues or concerns to Amy. We are committed to comply with the provisions of the Civil Rights Act of 1964 and 1991, plus all Executive Orders issued relating to Equal Employment. Amy's contact information is listed below. Heritage Construction and Materials P.O. Box 421459 Indianapolis, IN 46242 (317) 616-4907 (o) (317) 474-2559 (m) If im t John"Peisker, President Ca iftrtttr Jorf (Qu tifu-ation ISSUED BY INDIANAPOLIS, IN TO WALSH & KELLY INC MAE, May 21, 2020 GRIFFITH, IN who has filed with the Department a Contractor's Statement of Experience and Financial Condition as required under Indiana Code 8-23-10, is hereby qualified to bid at any Department of Transportation letting in Classes of Work and within the amount and other limitation of each classification as listed below, for such period as the uncompleted work on hand from all sources does not exceed the Aggregate amount. Classification references by name or symbol are in accordance with the definitions in the Contractor's Statement of Experience and Financial Condition. This certificate supersedes any certificate previously issued, but is subject to revision or revocation according to the law, if and when changes in the financial condition of the contracting firm or other facts justify such revision or revocation. Valid May 21, 2020 Thru April 30, 2021 AGGREGATE....................................................................................................................................... $UNLIMITED A(B) CONCRETE PAVEMENT: LIMITED......................................................................................................... $25,000,000 B(A) ASPHALT PVMT:W/INDOT CERTIFIED HMA PLANT..........................................................................$UNLIMITED C(B) LIGHT GRADING........................................................................................................................................$UNLIMITED E(E) SMALL STRUCTURES AND DRAINAGE ITEMS.................................................................................... $25,000,000 E(F) SURFACE MASONRY AND MISC CONCRETE....................................................................................... $50,000,000 E(G) TRAFFIC CONTROL: PAVEMENT MARKINGS...................................................................................... $25,000,000 E(H) DEEP SEWER AND/OR EXCAVATION.................................................................................................... $25,000,000 E(Q) CONCRETE PAVEMENT: REPAIRS......................................................................................................... $25,000,000 E(R) ASPHALT PAVEMENT MILLING.............................................................................................................. $50,000,000 PREQUALIFICATION ENGINEER State Form 20508 (R3 / 5-05) COMMISSIONER o0,!k II If OF SOL 0. 11 .BUND 1V W.MTTII WlYE(i( ' A. �A O!G'M K. Project Number: 120-043 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: 8/7/20 This addendum is being forwarded to you for the above referenced project. Please sign below and acknowledge receipt of this Addendum by faxing this sheet to the Board of Public Works at (574) 235-9171 within 48 hours of receipt. A copy MUST also be included with your bid package upon submittal. THIS ADDENDUM MAY AFFECT YOUR BID. Notes: The attached documents are hereby added to the Specifications and Contract Documents and become a part of herein. Company: Walsh & Kelly, I Authorized Signature: Dbs 'O Hilary, V� aft outh Bend Area Date: ..,,,8/11/20 __. Version 4/2/2015 CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK RESPONSIBLE BIDDER CHECKLIST Project Name Century Center Esports Arena Project No. 119-106CR For Bids Due September 8, 2020 by 9:30 AM Local Time Contractor Name: TPC Technologies, Inc. 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 II acts as an application for pre -qualification. Submission of Section II 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 31 st 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. Version 5/16/2019 General Conditions - 6 POST BID SUBMISSIONS: Post -bid submissions must be submitted in accordance with Section 6-64 of the Responsible Bidding Ordinance. The post -bid submission requirements are as follows: All bidders shall collect, maintain, and provide upon request, a current written list that discloses the name, address, licensing status, and type of work for any subcontractor from whom the bidder has accepted a bid and/or intends to hire on any part of the public work project, including individuals performing work as independent contractors. Each subcontractor, whose portion of the project is estimated to be at least one -hundred fifty thousand dollars ($150,000.00), shall be required to adhere to the requirements of Section I of the Responsible Bidder Ordinance as though it were bidding directly to the City, except that the subcontractor shall submit the required information (including the name, address, and type of work) to the successful bidder prior to the commencement of work. Failure of a subcontractor to submit the required information shall not disqualify the successful bidder from performing work on the project and shall not constitute a contractual default and/or breach by the successful bidder. However, the City may withhold all payment otherwise due for work performed by a subcontractor, until the subcontractor submits the required information and the City approves such information. 4. The disclosure of a subcontractor list ("Disclosed Subcontractor(s)") to the City by a bidder shall not create any rights in the Disclosed Subcontractor(s). Thus, a bidder may substitute another subcontractor for a Disclosed Subcontractor by giving the City, upon request, written notice of the name, address, licensing status, and type of work of the substitute subcontractor. 5. The successful bidder and all subcontractors on a public works project are required to submit certified payroll utilizing the federal form known as WH-347 or a similar form on a bi-weekly basis, submitted within 10 days after the end of each bi-weekly payroll period. Certified payrolls shall identify the job title and craft for each employee. Certified payrolls shall be submitted electronically. Please Note: Submissions deemed inadequate, incomplete, or untimely by the City may result in the automatic disqualification of the bid. The City, after review of complete and timely submissions, shall, in its sole discretion, after taking into account all information in the submission requirements, determine whether a bidder is responsive and responsible, and provide a Pre -Qualification Verification Letter. The City specifically reserves the right to utilize all information provided in the contractor's submission and any information obtained by the City through its own independent verification of the information provided by the contractor. Version 5/16/2019 General Conditions - 7 I. PRE -QUALIFIED BIDDER CHECKLIST (a) Acknowledgements: W X By checking this box, I hereby acknowledge that I am a pre -qualified bidder with the City of South Bend and that I have met the pre -qualification requirements within the last twelve (12) months. A copy of my Pre -Qualification verification letter is attached. (ii) X By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided by me, and may also conduct random inquiries of my current and prior customers. (b) Attachments: (i) X Indiana Secretary of State's on-line records (ie. Business verification) dated within sixty (60) days of the submission of said document showing that business is in existence, current with the Indiana Secretary of State's Business Entity Report, and eligible for a certificate of good standing. (Not applicable to individuals, sole proprietors or partnerships). (ii) X Statement on staffing capabilities, including labor sources. This statement indicates and ensures I have sufficient employees on staff to complete the work. It outlines how I intend to meet the staffing needs of the work. (iii) X List of projects of similar size and scope of work performed in all areas, including the State of Indiana, within the last three (3) years. (iv) X For every project, submit evidence of participation in apprenticeship and training programs, applicable to the work to be performed on the project, which are approved by and registered with the United States Department of Labor's Office of Apprenticeship, or its successor organization. Version 5/16/2019 General Conditions - 8 PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED) (a) Acknowledgements: (i) _ By checking this box, I hereby acknowledge that I am not a pre -qualified bidder with the City of South Bend. (ii) _ By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided, and may also conduct random inquiries of my current and prior customers. The City reserved the right to utilize all information provided in this submission and all information obtained in inquiries or requests to determine if a bidder is responsive and responsible. Additionally, I acknowledge that all information provided to the City shall be regarded as public records. (iii) _ By checking this box, I hereby acknowledge that copies of all Applicable apprenticeship certificates or standards for training programs applicable to the work performed on the project may be requested at any time and shall be furnished upon request. (iv) _ By checking this box, I hereby acknowledge and ensure that I and all sub- contractors, from whom I have accepted a bid and/or intend to hire to perform work on the public work project, are properly licensed. Furthermore, I acknowledge my understanding that it is my responsibility to ensure that all sub -contractors have the necessary licenses to undertake the work called for in this bid. If a sub- contractor loses their license at any point, it is the responsibility of that sub- contractor to notify the City. (b) Attachments: (i) _ Indiana Secretary of State's on-line records (ie. Business verification) dated within sixty (60) days of the submission of said document showing that business is in existence, current with the Indiana Secretary of State's Business Entity Report, and eligible for a certificate of good standing. (Not applicable to individuals, sole proprietors or partnerships). (ii) _ List identifying all former business names. (iii) _ Any determinations by a court or governmental agency any violations of federal state, or local laws including, but not limited to, violations of contracting or antitrust laws, tax or licensing laws, environmental laws, Occupational Safety and Health Act (OSHA), or federal Davis -Bacon and related Acts, within the preceding five (5) years. (iv) _ Statement about staffing capabilities, including labor sources. This statement indicates and ensures I have sufficient employees on staff to complete the work I am bidding on OR outlines how I intend to meet the staffing needs of the work. (v) _ Statement that individuals who will perform work on the public work project on my behalf will be properly classified as an employee or as an independent contractor under all applicable state and federal laws and local ordinances. (vi) _ For every project, submit evidence of participation in apprenticeship and training programs, applicable to the work to be performed on the project, which are approved by and registered with the United States Department of Labor's Office of Apprenticeship, or its successor organization. (vii) _ Copy of a written plan for employee drug testing that covers all of my employees who will perform work on the public work project and meets or exceeds the requirements set forth in IC 4-13-18-5 or IC 4-13-18-6. (viii) _ Evidence that I am utilizing a surety company which is on the Bureau of Fiscal Service "Department of Treasury's Listing of Approved Sureties" as required in the bid specifications or contract. Version 5/16/2019 General Conditions - 9 (ix) _ Written statement of any federal, state or local tax liens or tax delinquencies owed to any federal, state or local taxing body in the preceding three years. (i) _ List of projects of similar size and scope of work performed in all areas, including the State of Indiana, within three (3) years prior to the date on which the bid is due. Date: 09/04/2020 41111 (Sign Here) "` '" Kenneth A. Kuespert (Print Name Here) TPC Technologies, Inc. (Name of Company) 165 Pell Rd. (Address of Company) Niles (City) I, 49120 (State) (269) 637-9793 (Telephone Number) Version 5/16/2019 General Conditions - 10 CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK CHECKLIST FOR BIDDERS Project Name Century Center Esports Arena Project No. 119-106CR For Bids Due September 8, 2020 by 9:30 AM 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 X or Bid Bond. Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely X executed. Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and X Certification of use of United States Steel Products or Foundry Products. Proof of MBE/WBE Participation Goal Form [MWBE-1.0]. If minimum participation goal is not met, also provide Evidence of Good Faith Efforts Form [MWBE-2.0] and MBE/WBE Contacted X Form [MWBE-2.1]. Acknowledge Receipt of Addendum(s) included with the bid. X All required additional information is included with the bid. Proposal statements and other affidavits all signed by the proper party with name either X printed or typed underneath signature. X This checklist submitted with the Bid. This checklist is provided for bidder's use in assuring compliance with required documentation; however, it does not include all specifications requirements and does not relieve the bidder of the need to read and comply with the specifications. Bidder: TPC Technologies, Inc. By Authorized Repre Signature: Print Name & Title: Martin Golc , Sales Manager Date: 09/04/2020 Version 4/2/2019 Contractor's Bid for Public Works - 1 CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK Project Name Project No. For Bids Due Century Center Esports Arena 119-106CR September 8, 2020 by 9:30 AM Local Time PART I (Must be completed for all bids. Please type or print) Date: 09/04/2020 Bidder (Firm): TPC Technologies, Inc. Address: 185 Bell Rd. City/State/Zip: Niles, MI49120 Telephone Number: ( 269 ) 687-9796 Agent of Bidder (if Applicable): n/a Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the public works project of: Century Center Esports Arena - Project No. 119-106CR the City of South Bend, Indiana, in accordance with plans and specifications prepared by: SimplyNew, LLC, 12575 Beatrice Street, Playa Vista, CA 90066 and dated 09/04/2020 for the sum of (enter the Total Bid as shown on the Proposal) Six Hundred, Nineteen Thousand, Three Hundred, Seventy -One Dollars and 55/100 ($ 619,371.55 ) (Enter sum of Total Base Bid plus Alternates shown on Proposal) (Numerical) The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the notice. Any addendums attached will be specifically referenced at the applicable page. 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 ate attachment. By Ma i C�olob, Sales � �ge� The above bid is accepted this Subject to the following conditions: BOARD OF PUBLIC WORKS Gary A. Gilot, President Elizabeth A. Maradik, Member Joseph R. Molnar, Member ACCEPTANCE -_- day of (Printed Name of Person Signing) Jordan V. Gathers, Member Therese J. Dorau, Member Attest: Linda M. Martin, Clerk 20 Version 4/2/2019 Contractor's Bid for Public Works - 2 (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/her/its bid. Attach additional pages for each section as needed. SECTION I EXPERIENCE QUESTIONNAIRE 1. Attach information regarding projects your organization has completed for the period of one (1) year prior to the date of the current bid. 2. Attach a listing of public works projects currently in process of construction by your organization. 3. Attach information regarding any failure to complete any work awarded to you and the location thereof. 4. Attach references from private firms for which you have performed work. SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE 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. When the prospective Contractor is unable to certify to any of'the statements below, it shall attach an explanation to this Affidavit. Version 4/2/2019 Contractor's Bid for Public Works - 3 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 M I ) SS: Berrien COUNTY ) The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury that: 1. Contractor has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and 2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency; and 3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investment activities in Iran. a. For purposes of this Certification, "Iran" means the government of Iran and any agency or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from time -to -time. b. As provided by Ind. Code § 5-22-16.5-8, 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. 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 Version 4/2/2019 Contractor's Bid for Public Works - 4 newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3. Contractor's documentation of enrollment and participation in the E-Verify Program is included and attached as part of this bid/quote; and 5. Contractor shall require his/her/its subcontractors performing work under this public contract to certify that the subcontractors do not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the subcontractor subsequently learns is an unauthorized alien, and that the subcontractor has enrolled in and is participating in the E-Verify Program. The Contractor agrees to maintain this certification throughout the term of the contract with the City of South Bend, and understands that the City may terminate the contract for default if the Contractor fails to cure a breach of this provision no later than thirty (30) days after being notified by the City. 6. Persons, 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 may consider the Contractor's good faith efforts to obtain participation by those Contractors 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. In no event shall persons or entities seeking the award of a City contract be required to award a subcontract to an MBE/WBE; however, it may not unlawfully discriminate against said WBE/MBE. A finding of a discriminatory practice by the City's MBE/WBE Utilization Board shall prohibit that person or entity 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 for which the discriminatory practice or noncompliance pertains. 7. The undersigned contractor agrees that the following nondiscrimination commitment shall be made a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its agencies, boards or commissions. Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the performance of this contract with privileges of employment, or any matter directly or indirectly related to employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation, handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of contract. I, the undersigned bidder or agent as contractor on a public works project, understand my statutory obligations to the use of steel products or foundry products made in the United States (I. C. 5-16-8-1). I hereby certify that I and all subcontractors employed by me for this project will use steel products or foundry products made in the United States on this project if awarded. I understand I have an affirmative duty to notify the City in my bid that my proposal does not include the use of steel products or foundry products made in the United States. I understand it is my sole obligation and responsibility to provide a justification to the City, subject to review and approval, why the cost of United States made steel or foundry products is unreasonable. Prior to award and upon submission of bid which does not use steel products or foundry products made in the United States, the City, through its director of public works, shall make a determination if the price of United States made steel or foundry is unreasonable. I understand that violations hereunder may result in forfeiture of contractual payments. Version 4/2/2019 Contractor's Bid for Public Works - 5 I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for public works are true and correct. Dated this day of , 20 Subscribed and sworn to before me this My Commission Expires County of Residence TPC Technologies, Inc Contractor/Bidder (Firm) SEE DIGITAL COPY W/ SEAL Signature of Contractor/Bidder or Its Agent Printed Name and Title day of , 20 SEE DIGITAL COPY / SEAL Notary Public Version 4/2/2019 Contractor's Bid for Public Works - 6 BID/PROPOSAL CITY OFSOUTH BEND Project Name: —Century CantarEsports Arena Project Number: 119-106CR For Bids Due: September 8.2D2DbyS:3DAK8Local Time Contractor Name: TPC Technologies, INC BASE BID Item Description Quantity Unit Unit Price Total Amount BASE BID TOTAL $819.371.55 Bidder (Firm): TPCTechnologies, Inc. 1��BeU�d Address: . City/State/Zip: Niles, K1|49127 Telephone 687-9798 By Martin Golob, Sales Manager (Printed Name ofPerson Signing) Version 4/2/2019 Contractor's Bid for Public Works - 7 F- LU 0 W N w a� La LU z F- c� mw 0 a 0zz N N W 0 m a 0 F-ww VFW OD 0 z a H R 0 z_ 5 z 0 �a �a LU U mF- �a �w �m 0LL LU m W m O O C Vl 0 _ O C � 'y c� 3 N a O y a L � O N N d w i �= a m� 0 O V! O w co Lo O r� O _ U U c L 42 E c 'O d N N — CL A +� c tv ca ai +�+ L E V! t co z m t U t ) � d L 2 > N sZ p V CL� o N � � � O � O O Q t Vl V! i 0 y i N ++ N O p E Q�'vJdZ O GN -a u t N N N C H = O LU m 0 0 w m i L .. 'm co 0 0 E HQ O N o m U) O Q O d O co co m m ;3 0- 0 o rn m � c � U � d � c a� 0 o is Q 00 EU Q W D m � p ED 0 0 o O 0 0 a) N a CL a) Q O O N U) 0 tu c U 0 a o t m ;3 0 a�i C) a� E m m E z ai d � e� Q7 cn LU 0 W oD o 0 U)i cn N (D Q 0 E F- m Z 0 N 0 COI 0 CD E 0 U) -0 N co 0 N E co z c V1 ^a CITY OF SOUTH BEND 4 °UTLF , MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY' DEVELOPMENT PROGRAM "- FORM MWBE-2.0 EVIDENCE OF GOOD FAITH EFFORTS labs" This completed form should be included as part of the Bids documents related to City of South Bend Public Works Projects requiring Good Faith Efforts to obtain MBE/WBE participation. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business as defined by the Indiana Department of Administration ("IDOA"). Project Number: 119-106CR Date: 09/04/2020 Project Name: Century Center Esports Arena Bidder: TPC Technologies, Inc Contact Person: Martin G®lob Telephone: 269.687.979E Address: 185 Bell Rd. City: Email: State: Ml mgolob@tpctechnologies.com Zip ►,; To determine whether a bidder has demonstrated good faith efforts to reach the MBE/WBE utilization goals set forth in the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or commissions, REQUIRE ALL of the following Good Faith Efforts as listed in the table below": EVIDENCE OF GOOD FAITH EFFORTS MBE/WBE 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 (ADVERTISE/CONTACT): In order for your bid to be deemed responsive, the City of South Bend requires that all perspective bidders complete no less than 2 of the following: 1. Attend all pre -bid meetings scheduled by the City to inform MBE/WBEs of contracting and subcontracting opportunities. 2. Advertise in general circulation and/or trade association publications concerning subcontracting opportunities, and allow MBE/WBEs reasonable time to respond. 3. Perform any and all necessary steps to provide written notice in a manner reasonably calculated to inform MBE/WBEs of subcontracting opportunities and allowed sufficient time for them to participate effectively. 4. Utilize pre-existing services of available community organizations, small and/or disadvantaged business assistance offices and other organizations that provided assistance in the recruitment and placement of MBE/WBE firms. ""Bidder must circle or otherwise notate which of the two (2) required actions were performed. GOOD FAITH NEGOTIATIONS: The bidder negotiated in good faith with interested MBE/WBEs, including providing such MBE/WBE's with adequate information aboutthe 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 MBE/WBE goals (including breaking down contracts into smaller units to facilitate MBE/WBE 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 MBE/WBE 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. TPC does not require the services of any outside contractors for the completion of this project, therefore, none were pursued Version 4/2/2019 Contractor's Bid for Public Works - 9 CITY OF SOUTH BEND 4 °UTLF , MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY' DEVELOPMENT PROGRAM "- FORM MWBE-2.1 MBE/WBE CONTACTED labs" This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring contacted MBE/WBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business. Project Number: Project Name: Bidder: 119-106CR Century Center Esports Arena ,/T�P Technologies, Inc. PAGE OF. MBE/WBE Participation Goal n/a By: , %,--...,- Sales Manager 0/04/2020 (Si-gnat*W , (Title) (Date) MBE/WBE Firm Owner or Contact at MBE/WBE Firm Telephone Fax Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: TPC does not require the services of any outside contractors for the completion of this project, therefore, none were pursued RESULTS OF CONTACT WITH THE MBE/WBE FIRM: MBE/WBE Firm Owner or Contact at MBE/WBE Firm Telephone Fax Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBE/WBE FIRM: Version 4/2/2019 Contractor's Bid for Public Works - 10 brit. SAIA Document A31 OTM -2010 CONTRACTOR: (Narne, legal status and address) I IV [ echnologics, Inc. 185 Bell Road Niles, MI,49120 OWNER: (Nance, legal status and address) City of'South Bend hoard offlublic Works SURETY: (Name;, legal status arid principal place ot"business) FVC1 Insurance C'OnlpanN Sarasota. H. County -City Building l3th Floor, Room 1.310, 227 West Jefferson South [lend. IN 46601 BOND AMOUNT: five Percent of the Fo[af Bid 5') 1) of I otal I lid PROJECT: (Narne, location or address, and project number, ifany) Century Center Fsports Arena 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. fhe Contractor and Surety are bound to the Owner in the ainoun( set forth above, for the payment of'which the Contractor and Surety bind themselves, then- heirs, executors, adrit inistrators, successors and assigns, jointly and severally, as provided herein. The conditions ofthis Bond are such that if the Owner accepts the bid of the Contractor within the time specified in the bid docurnents, or within such time period as may be agreed to by the (..)wrier and and the Contractor either ( I) enters into a contract with the Owner in accordance with the terms of such bid, and gives Such bond or bonds as may be specified in the bidding or Contract Documents, with a Surety admitted in the jurisdiction of the project and otherwise acceptable to tire Owner, for the faithftil perfortriance ot'such Contract and For the prompt payment ()I'Iab(.)r and material furnished in the prosecution thereof- or (2) pays to the Owner the difference, riot. to exceed the amount ofthis Bond, between the afTIOUnt specified in said bid and such larger antOLtnt for which the ()wrier nray in good faith contract with another party to perforin the work covered by said bid, then this obligation shall he trull and void, otherwise to remain in full force and effect. The Surety hereby waives any notice of at) 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 riot apply to any extension exceeding sixty (60) days it) the aggregate beyond the time for acceptance of bids specified in the bid clOCUrnents, and the (,)wrier and Contractor shall obtain the Surety's consent for air extension beyond sixty (60) days. If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall be deemed to be Subcontractor and the terin Owner shall be deerned 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 deemed deleted herefrorni and provisions conforming to such statutory or other legal requirement shall be deerned incorporated herein. When so furnished, the intent is that this Bond shall be construed as a statutory bond and not as a COMIT1011 law bond. Signed and sealed this fill day of Septernher 2020 I'llc I cc] niologies, Inc, Ntrl (Seal) �5510` (ritleXenneth A'X U' pert, Presindet f,'(. (1 InSlAranceconipan\ (Surety (Witness) , t ' critic toWe' i111 " act CAU1101C You shourM sugn art odgVnal A11A Contract DOCUrnerit, 01in which As text appears ln RED, Arii origins] assures thiat changes wHf iunot be obscured. AIA Document A3101" - 2010. Copyright �F) 1963 1970 and 2010 by The American Institute of Architects. All rights reserved, WARNWG� I his ALA" Docume"t is probected by U S, (,opyrlW,it I aw and nternatioinW q'reafies, Unauthohzed reproduction or distflbubon olf this AlIA" ll)ocurwient, or any poftkon of it, may result in severe, civit and crilirvirnar Ipeinaitirae, and wili The prosecuted to the irnax6nnurn extent possiblle undertram law. Purchasers are permitted to reprOdUce ter) (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects legal counsel, copyright@,aia.org 061110 FCC I Cillkoljp sNSoRANCf Know all men by these presents: That the FCC| Insurance Company. a Corporation organized and existing under the laws cfthe State ofFlorida (the ^Corporation^)does make, constitute and appoint: Nicole LBicknell; Mark EVVobba; Faith D.Ouot;Jennifer LKuaznio;William JCerneyU|;Barbara EPearson; Sandra L Junk; Jordan M Scheiber; Theresa M Burns; Megan E Riesenberg; Wesley L Mantooth; 11sa NIThonias Each, its true and lawful Attorney -In -Fact, to make, exeoute, seal and de|iver, for and on its behalf as ourety, and amits act and deed in all bonds and undertakings provided that no bond or undertaking or contract of suretyship executed under this authority shall exceed the sum of(not h)exceed $10.000.000.00)� $10.000.000.00 This Power of Attorney is made and executed by authority of Resolution adopted by the Board of Directors. That resolution also authorized any further action by the officers of the Company necessary to effectsuch transaction. The signatures below and the seal of the Corporation may be affixed by facaimi|e, and any such facsimile aiBncdunam or facsimile seal shall be binding upon the Corporation when so affixed and in the future with regard to any bond, undertaking orcontract ofsurety to which it is attached. In witness whereof, the FCCI Insurance Company has caused these presents to be signed byits duly authorized officers and its corporate seal tobehereunto affixed, this 13thday ofMay, 2O2O, Attest: Christopher Shoucair, President Christina D. Welch, EVP, General Counsel, FCQ Insurance Company Chief Audit & Compliance Officer, Secretary FCC|Insurance Company State ofFlorida County ofSarasota Before methis day personally appeared ChriatopherShoucair. who is personally known tomeand who executed the foregoing document for the purposes expressed therein. N1ycommission expires: 2/27/2023 Notary Public State ofFlorida County of Sarasota Before me this day personally appeared ChriatinaD. VVe|oh, who is personally known to me and who executed the foregoing document for the purposes expressed therein. My commission expire& 2/27/2023 Notary Public CERTIFICATE i the undersigned Secretary ofRCC| Insurance Company. a Florida Corporotion, DO HEREBY CERTIFY that the foregoing Power of Attorney remains in full force and has not been revoked-, and furthermore that the February 27, 2020 Resolution of the Board of Directors, referenced in said Power of Attorney, is now in force. Dated this day of �l Christina D.Welch, EVP.General Counsel, wowA-3592-*x*4 05/2020 1316 COUNTY -CITY BUILDING 227 W.JEFFERSON BOULEVARD SOUTH BEND, INDIANA 46601-1830 PHONE 574/235-9251 FAX 574/ 235-9171 TDD 574/ 235-5567 CITY OF SOUTH BEND JAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS Date: August 25, 2020 To: All Planholders From Linda M. Martin, Clerk, Board of Public Works Subject Addendum Number: 1 Project Name: Century Center Esports Arena Project No.: 119-106CR ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: 08/26/2020 This addendum is being forwarded to you for the above referenced project. Please sign below and acknowledge receipt of this Addendum by faxing this sheet to the Board of Public Works at (574) 235-9171 within 48 hours of receipt. A copy MUST also be included with your bid package upon submittal. THIS ADDENDUM MAY AFFECT YOUR BID. Notes: The attached documents are hereby added to the Specifications and Contract Documents and become a part of herein. Company: TPC Technologies, Inc. Authorized Signature: Date: 08/26/2020 • 1316 COUNTY -CITY BUILDING 227 W.JEFFERSON BOULEVARD SOUTH BEND, INDIANA 46601-1830 Date: August 25, 2020 To: All Planholders PHONE 574/235-9251 FAX 574/ 235-9171 TDD 574/ 235-5567 CITY OF SOUTH BEND JAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS Century Center Esports Arena 119-106CR Addendum No. 1 From: Rebecca Plantz, Project Engineer Attached is the pre -bid meeting agenda. The pre -bid meeting was live streamed on August 24, 2020 at 1:00 pm ET through Microsoft Teams, and it was noted that the shortened URL did not initially work until new links were sent to those who communicated interest. All information covered is on the agenda attached. Send all bids to bpwbids@southbendin.gov. Attachments: Pre -Bid Meeting Agenda -This addendum consists of a total 5 pages inclusive of "Acknowledgement of Receipt of Addendum" sheet- REGISTERED RETAIL MERCHANT CERTIFICATE CONTROL NUMBER Indiana Department of Revenue Government Center North Indianapolis, Indiana 46204 (317) 233-4015 TICS: 0111340861 TPC TECHNOLOGIES INCORPORATED LOG: 001 185 BELL RD FID: 38-3314837/0 NILES, MI 49120-4093 ISSUED: 01/03/20119 IS AUTHORIZED TO COLLECT INDIANA RETAIL SALES TAX AT THE ADDRESS ABOVE IF DIFFERENT FROM BELOW. EXPIRES�: 01/31/2021 THIS LICENSE: IS NOT'rRANSFERRABLETO ANY o'rHER PERSON, IS NOT SUBJECT TO REBA"rE. IS VOID IF ALTERED. ]ttill[HUIAUBUJUEUERUUUlILEUMI[IU TPC TECHNOLOGIES INCORPORATED 185 BELL RD NILES, IVII 49120-4093 (Detach Here) Dear Customer: Attached is your Registered Retail Merchant Certificate (RRIVIC). On your certificate, it shows your Taxpayer Identification Number (TID) and Location Number (LOC). Please make note of these important numbers. You will need to, use there on exemption certificates and for phone or written communication with the Indiana Department of Revenue (DOR). Please note the expiration date on the certificate. All Indiana RRMCs must be renewed every two, years with DOR. Merchants in good standing with DOR will automatically receive a renewed certificate. However, if a merchant has unpaid tax liability(ios) owed to DOR, they cannot renew their RRMC. All businesses are required to file sales andl/or withholding taxes online, Please register for INtax today at www.lNitax.in.gov. When registering, use your preapproved INtax activation code, 61 D54D513-1 861-90BC-EO43- OA07A8669OBC. With INtax, you also can manage your obligations for Indiana metered pump sales, tire fees, food and beverage tax, and fuel taxes. It also gives you 24/7 access to business --tax records, iets you file and pay online right up to the last deadline rninute, and saves you the cost and hassle of mailing in returns each month. If you have questions about your sales or withhoiding taxes, you may contact Customer Service at (317) 233-4015, Monday through Friday 8 a.m. - 430 p.m. EST, Sincerely, I Indiana Departmentof -Revenue - WO Technologies, r ProductionYour completeElectronic System Contractor and Mailing ✓ thiress 185 dell Road -Niles, MI 49120 Showroom AddrCWs 245 Bell Road • Niles, III 49120 Voice 269.687.9798 • Fax 269.687.9804 • www.tpetechnologies.com Our Company: TPC Technologies, Inc. (TPC) has been owned and operated by its full-time President, Ken Kuespert since 1985. TPC is both an A/V Systems Designer/Installer/Integrator as well as a Production Company with annual sales averaging $3.5 million, 10,000 sq/ft of warehouse and fabrication space and over $1.5 million in rentable A/V equipment. Our reputation has enabled us to establish relationships with over 150 of the industry's leading manufacturers, including names like Crestron, AMX, Sanyo, Epson, Crown, JBL, Shure & ETC. This blending of installation experience with production experience brings a unique advantage to our A/V Customers. Not only does TPC have an intrinsic working knowledge and ability to maintain the underlying components of A/V systems, but its years of production experience give us first-hand knowledge of the best way to provide A/V in any environment. Our People: TPC has a full-time staff of twelve with over 125 years combined experience in A/V Systems Design, Installation and Integration and a management to technical staff ratio of 1.2. We have ample capacity and skills to handle any number of simultaneous projects. TPC's full-time staff has a diverse background that supports our dual roles as A/V Systems Designer/Installer/Integrator and Production Company. Our full-time staff holds degrees, certifications and practical experience as follows: Degrees; MA — Theater Production & Organizational Leadership BS — Telecommunications Production BS — Radio/TV/Film BA — Business Administration (2) AS — Electrical Engineering Technology Certifications; QSC QSYS Certified Level 2 Crown IQ JBL Systems Architect Yamaha M7CL (2) AMX Designer AMX Installer AMX Programmer (2) Crestron DM Design Certified Crestron Programmer (2) Extron Certified ETC Factory Service Our Projects: Four Winds Casino, New Buffalo, South Bend, Hartford & Dowagiac, MI Event Center, Hard Rock Cafe, Three room conference center with AMX multi -room combining of lighting, audio, and video. Executive Conference Room and Private Dining Room with full AMX Multi -Media control. Casino Floor A/V control via AMX and BSS/London Matrix Howard Park, City of South Bend, IN Sound, lighting, video, network and controls for renovated Ice Park. Conference center with AMX multi -room combining of lighting, audio, and video. A/V control via AMX and BSS/London Matrix. Design by TPC and Alliance Architects and installation by TPC. Beacon Health System, Norther Indiana Extensive work at various locations throughout the Beacon network. Provided sound, lighting, video & control solutions. Teachers' Credit Union, South Bend, IN Provided sound, lighting, video & control solutions for call center, executive conference room and meeting spaces. Inn at Harbor Shores, St. Joseph, MI Three room conference center with multi -room combining of lighting, audio, and video. Complete integration with audio conference and satellite system. AMX control was used in this facility to complete this task. Design and installation was done by TPC. Notre Dame University —Notre Dame, IN Joyce Center Audio Distribution and Patching System. Classroom A/V system upgrades. 13 different classrooms from 100 to 400 seats. Electrovoice speakers, Ashly DSP, and Crown amps used throughout. Whirlpool, St. Joseph, MI Three room conference center with multi -room combining of lighting, audio, and video. Complete integration with audio conference and satellite system. AMX control was used in this facility to complete this task. Design and installation was done by TPC. St. Joseph Public Schools - St. Joseph, MI Classroom AV systems using an AMX based IP controlled AV system. Complete system with AV rack, Projector and screen. Web controlled and Ethernet managed. Auditorium (975 seat), Football stadium, Gym and Pool sound system design and installation. Complete voice, data and broadband for all St. Joseph Public schools covering six buildings. First Church of God — St. Joseph, Stevensville and Benton Harbor, MI Sound, lighting, video for a multi -campus community of faith. Trinity Lutheran Church — Elkhart, IN Sanctuary AV System. Page 2 of 3 Our References: Notre Dame University, Notre Dame, IN Jason Railton: Supervisor of Classroom Support 574.631.6306 Ron Grisoli: Washington Hall Program Manager 574.631.2805 Beacon Health System, Norther Indiana Mark Zakowski: Beacon Communications 574.286.3500 Teachers Credit Union, South Bend, IN Dan Rouseve: SVP & CIO 574.284.6317 Whirlpool Corporation, Benton Harbor, MI Daniel Velez: Senior Media Production Specialist 269.923.7641 First Church of God, St. Joseph, MI Jake Seaton: Worship Pastor: Stevensville Campus- 269.983.1524 Lakeshore Public Schools, Stevensville, MI Chris Quartermaine: Director of Technology 269.428.1402 St. Joseph Public Schools, St. Joseph, MI Bryan Parsons: Director of Technology 269.926.3255 Cassopolis Public Schools, Cassopolis, MI Dave VanLue: Principal of Ross Beatty High School 269.445.0506 Page 3 of 3