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HomeMy WebLinkAboutPSA - Restoration Design and Assistance with Historic Preservation Grant – K.W. Garner Consulting & Design1316 COUNTY -CITY BUILDING 227 W.JEFFERSON BOULEVARD SOUTH BEND, INDIANA 46601-1830 CITY OF SOUTH BEND JAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS September 8, 2020 Mr. Kurt West Garner K.W. Garner Consulting & Design 12954 6 h. Rd. Plymouth, IN 46563 RE: Professional Services Agreement Dear Mr. Garner: PHONE 574/235-9251 FAx 574/ 235-9171 The Board of Public Works, at its meeting held on September 8, 2020, approved the above referenced agreement for the restoration design, and assistance with the Historic Preservation Grant for the Walker Field Park Shelterhouse in an amount, not to exceed $9,250. Enclosed please find a copy of the agreement for your records. If you have any further questions regarding this matter, please call this office at (574) 235- 9251. Sincerely, s/Linda M. Martin, Clerk Enclosure GARY A. GILOT ELIZABETH A. MARADIK THERESE J. DORAU JORDAN V. GATHERS JOSEPH R. MOLNAR AGREEMENT FOR PROFESSIONAL SERVICES This Agreement For Professional Services (this "Agreement") is entered into on September 8, , 2020 (the "Effective Date"), by and between the City of South Bend, acting by and through its Board of Public Works (the "City"), and K. W. Garner Consulting & Design, with an office at 12954 6fh Road, Plymouth, Indiana 46563 (the "Provider") (each a "Party" and collectively the "Parties"). For and in consideration of the mutual covenants and promises contained herein, the Parties agree as follows: 1. Services. The Provider will provide to the City the professional services for Phase II of the Walker Field Shelter House Preservation Project (the "Services") set forth in the Provider's proposal attached hereto as Exhibit A (the "Proposal"), which Proposal is incorporated herein. In the event of any conflict between the terms of this Agreement and the terms of the Proposal, the terms of this Agreement will prevail. The Provider will execute its obligations under this Agreement in accordance with the prevailing professional standard of care for projects of similar design and complexity. 2. Compensation. In exchange for the Provider's satisfactory performance of the Services, and subject to the terms and conditions of this Agreement, the City will pay the Provider an amount not to exceed Nine Thousand Two Hundred Fifty Dollars ($9,250.00), inclusive of reimbursable expenses (the "Contract Amount") in accordance with the project budget stated in the Proposal. The City will pay the Contract Amount in installments upon invoicing by the Provider as set forth in the Proposal (each a "Contract Installment"). The City will not be required to pay any Contract Installment if the City is not satisfied with the Provider's performance under this Agreement or any default or breach of this Agreement by the Provider exists, as the City may determine in its sole discretion. The sum of all Contract Installments will not exceed the Contract Amount, and the Provider will not incur or seek reimbursement for any expenses in excess of the Contract Amount. 3. Term, Termination. Unless earlier terminated in accordance with its terms, this Agreement will commence on the Effective Date and end upon the Provider's satisfaction of all its obligations hereunder and the City's final payment therefor. Notwithstanding the foregoing, effective immediately upon delivery of a written termination notice to the Provider, the City may terminate this Agreement, in whole or in part, for any reason, if the City determines that such termination is in the best interest of the City. In addition, in accordance with Ind. Code 6-1.1-18- 4, payments are subject to annual appropriation by the City. If the City makes a written determination that funds are not appropriated or are otherwise unavailable to support the continuation of this Agreement, it shall be cancelled. A determination by the City that funds are not appropriated or are otherwise unavailable to support the continuation of performance shall be final and conclusive. The City will not be required to pay any Contract Installment or be otherwise liable for any cost associated with the Provider's performance of any Services after the effective date of termination. 4. Remedies for Breach of Contract. Failure to complete the Services in accordance 1 with this Agreement will be considered a material breach. In the event of such breach, the City may suspend all payments to the Provider and may pursue any and all remedies available at law or in equity. The Provider shall repay to the City any portion of the Contract Amount expended for matters not within the scope of the Services. 5. Point of Contact. The City employee identified in Section 9 below will serve as the City's principal point of contact for purposes of this Agreement. 6. Relationship. The Provider shall at all times be an independent contractor for the performance of the Services rather than an employee of the City, and no act or omission to act by the Provider shall in any way bind or obligate the City. This Agreement is strictly for the benefit of the Parties and not for any third party or person. This Agreement was negotiated by the Parties at arm's length and each of the parties hereto has reviewed the Agreement after the opportunity to consult with independent legal counsel. Neither party shall maintain that the language in the Agreement shall be construed against any signatory hereto. The City and the Provider hereby renounce the existence of any form of agency relationship, joint venture, or partnership between the Provider and the City and agree that nothing contained herein or in any document executed in connection herewith shall be construed as creating any such relationship between the City and the Provider. 7. Indemnification of City. The Provider hereby agrees to defend, indemnify, and hold harmless the City, its officials, employees, and agents from any and all claims of any nature which arise from the performance by the Provider under this Agreement and from all costs and attorney fees in connection therewith, excepting for claims arising out of the negligence of the City, its officials, directors, employees, and agents. The obligations of the Provider under this section shall survive the termination of this Agreement. 8. Assignment. The Provider shall not assign or subcontract the whole or any part of this Agreement or its obligations hereunder without the prior written consent of the City. 9. Notices. Any notice required or permitted to be delivered hereunder shall be deemed to be delivered, whether or not actually received, when deposited in the United States Postal Service, postage prepaid, registered or certified mail, return receipt requested, addressed to the City or the Provider, as the case may be, at the address set forth below. Provider- K.W. Garner Consulting & Design 12954 6th Rd. Plymouth, IN 46563 Attn: Kurt West Garner Lily: City of South Bend Department of Community Investment 227 W Jefferson Blvd., Ste. 1400S South Bend, IN 46601 Attn: Elicia Feasel 10. Equal Opportunity; Non -Discrimination; Compliance. The Provider shall comply with all applicable laws and regulations in its hiring and employment practices and policies for any activity covered by this Agreement. The Provider shall comply with all state, federal, and municipal laws, regulations, and standards applicable to its activities pursuant to this Agreement 2 including, but not limited to, the requirements imposed by Ind. Code 22-9-1-10 (non- discrimination), the provisions of Ind. Code 5-22-16.5 (disqualification for dealings with the government of Iran), and the provisions of Ind. Code 22-5-1.7 (requiring E-Verify for new employees and prohibiting employment of unauthorized aliens). Each of the foregoing provisions is incorporated herein as if set forth in full, and the Provider certifies that it is in compliance with each such provision and shall remain in compliance through the term of this Agreement. 11. Contractor's Affidavit. The Provider agrees, as a condition precedent to the effectiveness of this Agreement, that its authorized representative will execute and submit to the City and any other appropriate bodies an affidavit in the form attached hereto as Exhibit B. 12. Drug -Free Workplace. The Provider hereby agrees to make a good faith effort to provide and maintain a drug -free workplace. The Provider will give written notice to the City within ten (10) days after receiving actual notice that the Provider or an employee of the Provider within the State of Indiana has been convicted of a criminal drug violation occurring in the workplace. 13. Entire Agreement; Amendment; Applicable Law. This Agreement sets forth the entire agreement and understanding between the parties as to the subject matter hereof, and merges and supersedes all prior discussions, agreements, and understanding of any and every nature between them. This Agreement may be amended only by separate writing, signed by authorized representatives of both the Provider and the City. This Agreement will be construed and interpreted according to the laws of the State of Indiana, and any dispute arising out of this Agreement or otherwise concerning the Provider's rendering of the Services will be resolved in the courts located in St. Joseph County, Indiana, unless the Parties mutually agree to a different method of dispute resolution. 14. Severability. All provisions of this Agreement shall be considered as separate terms and conditions, and in the event any one shall be held illegal, invalid or unenforceable, all the other provisions hereof shall remain in full force and effect as if the illegal, invalid, or unenforceable provision were not a part hereof, unless the provision held illegal, invalid or unenforceable is a material provision of this Agreement, in which case the Provider and the City agree to amend this Agreement with replacement provisions containing mutually acceptable terms and conditions. 15. No Waiver. No failure or delay on the part of either Party in exercising any right under this Agreement will operate as a waiver of, or impair, any such right. No single or partial exercise of any such right will preclude any other or further exercise thereof or the exercise of any other right. No waiver of any such right will have effect unless given in a written document signed by the Party waiving such right. No waiver of any right will be deemed a waiver of any other right hereunder. 16. Force Majeure. The Provider shall not be responsible for any failure or delay in the performance of any obligation hereunder, if such failure or delay is due to a cause beyond the Provider's reasonable control, including, but not limited to acts of God, nature, or government. 17. Counterparts. This Agreement may be executed in two or more counterparts, which together shall constitute one and the same agreement among the Parties. IN WITNESS WHEREOF, the Parties hereto have caused this Agreement for Professional Services to be effective as of the Effective Date stated above. CITY: CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS Gary A. Gilot, President Elizabeth A. Maradik, Member �:.� . °z_.� ��._<, "•,ram--.,�. Therese J. Doran, Member Jordan V. Gathers, Member Joseph R. Molnar, Member ATTEST: itz a G�-Tarz#1 Linda M. Martin, Clerk By. I u 'est Gam T. ri ncipal 4 EXHIBIT A Proposal [See attached.] 24203589.2 sw r August 19, 2020 Walker Field Shelterhouse Preservation Project City of South Bend Department of Community Investment Historic Preservation 227 W. Jefferson Blvd., Ste. 1400 South Bend, IN 46601 C/o Elicia Feasel Historic Preservation Administrator Dear Elicia, It was pleasant meeting with you several weeks ago to look at the Walker Field Park Shelterhouse and talk with you about upcoming plans to apply for Historic Preservation Funds through DHPA. While Works Progress Administration structures are not uncommon in the State of Indiana, this building is unique in its design with an arcaded area with wading pool. The building was constructed between 1938-39 and was listed on the National Register of Historic Places in 2010, making it eligible to receive preservation funding. Attached is a project Scope of Work broken into two phases. The first is a feasibility study/ planning for restoration and programming use of the building. It also includes general consulting and review of the grant application scheduled for October. The document will be beneficial in developing the grant application and should provide added weight in the competitive awards. The second phase is moving ahead with construction documents and principal investigative services if the grant is awarded. I am collaborating with Neil Hoerstman, AIA, of Hoerstman Design Shop in providing services for this project. Neil, who is a graduate of Marian High School, is a licensed architect who has ample experience in restoration studies for large masonry buildings. We believe together we can provide exceptional services for the work planned. My firm's profile and experience of comparable work as well as Mr. Hoerstman's resume are at the end of the proposal enclosed. Please let me know if there are any questions. Thank you. Sincerely, Kurt West Garner 12954 Piro . oad. Plymouth, Indiana 46563 - Telephone 574 9 3Fi-061 3 kwgarrier . com PROJECT SCOPE OF WORK Phase 1 Feasibility Study The feasibility study will document the building for the creation of basic measured drawings, photographic documentation, and identification of areas to be addressed in restoration. The study will provide recommendations for preservation/restoration and programming. This will be in context with the broader site and neighborhood/park area and will incorporate input from key stakeholders and community members. Basic Drawings/Estimates The Consultant will provide basic restoration schematics for use in the grant application and for the development of more refined estimates for construction. This will focus on immediate needs of stabilization/preservation and securing the building. Grant Assistance The Consultant shall provide review and recommendations on the Historic Preservation Fund grant application scheduled for submission in October 2020. It is understood that the feasibility study will be included in the submission and will be referenced in the application to strengthen the overall project's fundability. Phase 2 Principal Investigator The Consultant will fulfill the duties for the Client for these positions as described in the Historic Preservation Fund manual/guidelines. This work will include review of construction drawings for compliance to the Secretary of the Interior's Standards for Rehabilitation of Historic Structures, a requirement of the grant. Submission of these drawings and other pertinent information to the state, and coordinating meetings with the state for project start-up and close-out shall be part of the Consultant's services. The work will require periodic review of restoration work being undertaken at the Shelterhouse, as well as communication and progress reports to the state. The Consultant will work with the Client for payment processing and contract negotiation with the contractor. While the Principal Investigator is not required under grant guidelines to provide construction documents for bidding/procurement purposes, as a Consultant prequalified with the State Historic Preservation Office for the preparation of these drawings and provision of these services, our team is able to complete this if desired, and is identified in the proposal under a separate fee under Phase 2. These drawings would build off of the initial restoration concept drawings being provided in Phase 1 for the feasibility study. Walker Field Shelterhouse Feasibility Study & Grant Services This Proposal for Services is between Kurt West Garner, Consultant, and the South Bend Historic Preservation Commission, Client, for feasibility/planning and grant services related to the Scope of Work for Walker Field Park Shelterhouse as noted previously. Fee: $ 9500.00 / $14,000.00 Phase 1: $ 5000 50% at time of documentation; 50% after delivery to the Client (about September 25). Reimbursable expenses related to this study, such as printing and postage, shall be billed to the client. Deliverables: Feasibility Study identifying restoration needs and programming goals Budget estimates for immediate stabilization work/securing the building Consultation on HPF grant application The Consultant is responsible for completion of the report and presentation. The Client shall provide access to the building and any resources/history that may be necessary for drafting the report. Client may engage interested parties and community members for input on the study. Phase 2: a. $ 4500 principal investigator review services only or b. $ 9000 principal investigator services including documents/procurement Phase 2 is only activated if the Client's grant application for Historic Preservation Funds is successful and the project moves forward as planned. Payments as follows: equal payments over the proposed timeline of the project from review of documents through completion. The Consultant is responsible for duties outlined for Principal Investigator under the Historic Preservation Funds guidelines (2a). This does not include bid document/specification preparation, contractor procurement/bidding, or construction observation unless that scope is preferred under 2b. Client Consultant Authorized Signature Date Kurt West Garner Date 12954 Piro .Road. Plymouth, Indbeina 4656 - Telephone 574 9 Fi-061 kWg4 rriel.com K. W. Garner Consulting & Design was established in August 2008. The firm's purpose is to assist communities, organizations and individuals achieve their historic preservation goals and community development initiatives. With almost twenty-five years' experience across Indiana in historic preservation and federally assisted projects, clients are assured a high level of attention & satisfaction. K. W. Garner Consulting is listed on the roster of Prequalified Consultants for Indiana Landmarks Partners in Preservation program, Indiana State Historic Preservation Office, and Indiana Department of Transportation for Historical Architectural Investigation General Services Provide ➢ Feasibility Studies ➢ Section 106 Documentation ➢ Historic Property Reports ➢ Design ➢ HABS Reports ➢ National Register Nominations ➢ Historic Resource Mapping ➢ State Byway Development ➢ Interpretive plans/Community Development K. W. Garner Historic Preservation Consulting & Design Education, .Recognitions, and .Relevant Community Involvement Bachelor of Business Administration - Bethel College, 1991 Bachelor of Architecture - Andrews University, 1996 Graduate, Community Resource Planning, Ball State University, 1998 Distinguished Leadership Award, National Association for Community Leadership, 1999 Elected to Plymouth Council in 2003, Marshall County Commissioner in 2014 Plymouth Plan Commission &, Greater Downtown Study, 1999-2007 Founder, Wythougan Valley Preservation, President 1999-2003, 2009-present Consulting Party for projects undergoing Section 106 review through INDOT Historic Byway development; Co-founder and Vice-president of Historic Michigan Road. . RABLe The following are projects undertaken by KW Garner Consulting since 2008. They include a wide scope and scale of work related to feasibility studies for restoration, use, master planning. and resource identification. To -date, KW Garner Consulting &, Design has also authored over 170 nominations to the National Register of Historic Places and completed five multiple properties documentation forms. Feasibility Studies/.Restoration &v.IUaster,.Plarcrcirccj.Prafects Washington Park WPA Structures, Michigan City Maple Grove Camp, Huntingburg Douglass School, Kokomo Tryon Farms, Michigan City Veedersburg Railroad Depot Michigan City/Washington Park WPA Greenhouse Restoration Garret Theater Restoration & Use Study Monon Theater Restoration & Use Study Ligonier Synagogue Study Blackmore Cigar Company Building, North Manchester Cass County Children's Home Monterey Band Shell/Park Redevelopment Osterman Monument/Ideal Section, Lincoln Highway, Dyer Village of Maxinkuckee Resource Study &, Preservation Plan Hoosier Valley Railroad Master Plan, North Judson prir6palInvestigatorlGrant Writirccj.far,.Historic.Preser,uatiarc.Fu.t-t ed.Prafects North Liberty WPA Park Restoration Jacoby Church Restoration, Plymouth Marshall County Courthouse Restoration Old Plymouth Fire Station Restoration Other.Related Work for.Resource ldentification &v .Planrdr(g Historic Michigan Road Byway Corridor Management Plan Indiana Lincoln Highway Corridor Management Plan Hoosier Hills Byway Resource Study &, Application, Brown/Morgan Counties Angola Downtown Enhancement Project, Section 106 Survey South Bend Historic Preservation Commission Guidelines Update N EI L HOERSTMAN, AIA neil@hoerstmandesignshop.com 1317.225.6970 PROFESSIONAL EXPERIENCE Principal Architect, Hoerstman Design Shop, Indianapolis, IN June 2020 — Present Project Architect, Rowland Design, Indianapolis, IN September 2016 - June 2020 Fabricator & Designer, Midwest Studios, Indianapolis, IN May 2015 - September 2016 Project Manager, Gradison Design + Build, Indianapolis, IN September 2013 - May 2015 Carpenter, Hoerstman General Contracting, Mishawaka, IN Seasonal; June 2003 - Sept. 2013 VOLUNTEER EXPERIENCE AIA Indianapolis Home Tour Committee and Current Chair, February 2017 - Current Habitat For Humanity Young Professionals, February 2019 - Current Woodruff Place Historic Preservation Committee, January 2020 - Current EDUCATION Ball State University, Muncie, IN May 2013 Master of Architecture, College of Architecture and Planning Focus area: Urban housing Restoration Politecnico di Milano, Lecco, Italy Spring / Summer 2012 Architectural -Engineering Exchange Program Ball State University, Muncie, IN May 2011 Bachelor of Architecture, College of Architecture and Planning Minor: Construction Management MAJOR PROJECTS Pulaski County Courthouse - Phase 1: Concept for addition to existing Justice Center Pulaski County Courthouse - Phase 2: Concept for renovation of historic courthouse and Justice Center addition Marshall County Courthouse: Exterior facade assessment for the restoration of the clock tower Main Street Residence: Restoration of historic home in collaboration with EcoRehab of Muncie 522 & 527 Gharkey Street Residences: Restoration of historic home in collaboration with EcoRehab of Muncie Columbia Club - Platinum Lounge: Renovation of 2,200 SF of suite rooms into a piano bar and lounge Columbia Club - Co -work Space: Renovation of 1,800 SF of suite rooms into office space IAA Downtown Heliport: Restoration of exterior facade with construction budget of $290,000 Warehouse / Loft Concept Design: New build of 28,000 SF warehouse Clay Terrace - Paseos Redesign: Exterior site design for renovation of pedestrian walkways Tri Delta - Butler University: Restoration of 15,000 SF and addition of 11,000 SF with construction budget of $6M Alpha Epsilon Phi - Indiana University: Interior and exterior renovations with construction budget of $750,000 Cummings Residence: New build garage in the Old North Side Historic District Rowland Residence: Renovation and addition of single family home in the Brendonwood Historic District Serge Residence: Renovation and addition of single family home Rode Residence: New build carriage house and master bathroom renovation Dimond Residence: Renovation and addition; featured on 2019 AIA Indiana Home Tour Waggoner Residence: Renovation of kitchen and living space Schiesz Residence: New build concept of 5,000 SF home Brown Residence: Renovation and addition of single family home Howard Residence: Addition of detached garage to match the existing Evans Woollen designed home Waters Residence: Renovation and addition of single family home EXHIBIT B Contractor's Affidavit [See attached.] When lite prospective Contractor is unable to certify to any of lire statements beloly, 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 Chia )"`* BRIAN A. WUJCIK ) SS: Commlesion Number 0715473 cu— al COUNTY )SEAL * My Commission Expires OF I August 27, 2026 The undersigned Contractor, being duly svrol'I ]ills UR er penalties of petjuty 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 finther 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 fi-om time -to -time. b. As provided by hid. 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 Non -Collusion Nun -Debarment Affidavit Non Iran Fonn 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 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. Per -sons, partnerships, corporations, associations, or joint venturers awarded a contract by the City of South Bend through its agencies, boards, or conmissions 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 VIBE/WBE; however, it may not unlawfully discriminate against said WBE/MBE. 1', 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. Non, Collusion Nome -Debarment Affidavit Non Iran Form 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 on this project if awarded. I understand that violations hereunder 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,,-,- J/ day of,IZ-1, 20 Contractor/Bidder (1{irm Sign,At ire of Co °actor/bidder or Its Agent Printed Name and Title Subscribed and sworn to before me this _ day of 6c4, 20,�-Q My Cornmission Expires, _ it i..... :.. � .. ._..... y Notary Public w. County of Residence_ ITw..- ,........ BRIAN A. WUJCIK SEAL COMMISSION Numbor 0715473 MY COMMInion Expires OF 10 Auoud 27, 2025 Non -Collusion Non-Debannent Affidavit Non rran Form BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 9/3/20 Name Elicia Feasel Department C.I. BPW Date 9/08/2020 Phone Extension 7672 Review and Approval Required Prior to Submittal to Board Diversity Compliance and Inclusion Officer ❑ Officer Name BPW Attorney ❑ Attorney Name Dept. Attorney ❑ Attorney Name Purchasing ❑ Check the Appropriate Item Type — Re uired or All Submissions ® Professional Services Agreement ❑ Contract ❑ Proposal ❑ Open Market Contract ❑ Amendment/Addendum ❑ Special Purchase, QPA ❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet ❑ Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes ❑ Proposal Opening ❑ C/O & PCA No. ❑ PCA ❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution n Other: n Ease./Encroach Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description Information K.W. Garner Consultin4 & D U Yes U If Yes, Approved by Purchasing ® No ❑ WBE Completed E-Verify Form Attached ❑ Yes No Walker Field Shelterhouse Preservation Project 408-10-101-124-444000-PROJ00000212 $9,250.00 Principal Investigator for HPF grant and bid document/specification preparation, contractor procurement/bidding, and construction observation. For Change Orders Only Amount of ❑ Increase $ ❑ Decrease ($ ) Previous Amount Current Percent of Change: New Amount Increase Decrease Increase Total Percent of Change: Decrease Time Extension Amount: New Combletion Date: