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Home My WebLink AboutOpening of Bids - 3400 Block S. Michigan Street Improvements Proj No. 120-062 - Premium Concrete Services, Inc.CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK CHECKLIST FOR BIDDERS Project Name 3400 Block S. Michigan Street Improvements Project No. 120-062 For Bids Due February 23, 2021 From time to time the South Bend Board of Public Works finds it necessary to reject a bid because it does not comply with statutory requirements. In preparing your bid, please use the following checklist in order to make sure that your bid is done in the proper manner. Proper bid security included. The bidder has the option of providing either a Certified Check or Bid Bond. Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely (/ executed. Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments / with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and V Certification of use of United States Steel Products or Foundry Products. Proof of MWBE Utilization Plan [MWBE-1.0]. If minimum participation goal is not met, also provide Evidence of Good Faith Efforts Form [MWBE-2.0] and MWBE Contacted Form v [MWBE-2.1]. Acknowledge Receipt of I Addendum(s) included with the bid. V All required additional information is included with the bid. / Proposal statements and other affidavits all signed by the proper party with name either printed or typed underneath signature. V 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: PR&.r»s4,-1 COnlGRfirS- S6-:RVc'c�-- 3 Date: -M2312- By Authorized Signature: Print Name & Title: 1;1WA1'1< Version 01/13/2021 Contractor's Bid for Public Works - 1 CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK Project Name 3400 Block S. Michigan Street Improvements Project No. 120-062 For Bids Due February 23, 2021 PART I (Must be completed for all bids. Please type or print) Date: 2/23/21 Bidder (Firm): Address: City/State/Zip: 712 RICHMOND ST PREMIUM CONCRETE SERVICES, INC ELKHART Telephone Number: ( 574 ) 264-0196 Agent of Bidder (if Applicable): Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the public works project of: 3400 BLOCK S MICHIGAN STREET IMPROVEMENTS the City of South Bend, Indiana, in accordance with plans and specifications prepared by: JONES PETRIE RAPINSKI and dated 1/27/21 IIAke- I�UAO C.4) SOlin (Enter sum of Total Base Bid r _ for the sum of (enter the Total Bid as shown on the Proposal) i/lou44n/0 /Gras& IAO&44E0 10T A ($ 3'73, 909 °" ) ,Iternates shown on Proposal) ✓e",ej (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 a�separate attachment. By /r9 (Signature) RD(S �JE�Ac�jZ (Printed Name of Person Signing) ACCEPTANCE The above bid is accepted this day of Subject to the following conditions: BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Gary A. Gilot, Member Jordan 1. Gathers, Member Joseph R. Molnar, Member Attest: Anne Fuchs, Clerk Version 01/13/2021 Contractor's Bid for Public Works - 2 20 BID/PROPOSAL CITY OF SOUTH BEND Project Name: 3400 Block S. Michigan Street Improvements Project Number: For Bids Due: 120-062 23,2021 Contractor Name: 09mrktol 5J5x0XCk5 X-A)G BASF Bin Item Description Quantity Unit Unit Price Total Amount No. 1 CONSTRUCTION ENGINEERING 1 LS cDD Cb SSo 2 MAINTENANCE OF TRAFFIC 1 LS (Spaa /5Or>0 3 MOBILIZATION AND 1 LS /SbDO `SbLb DEMOBILIZATION 1 LS SOD (pCi� o0 4 VIDEO RECORD 5 ASPHALT PAVEMENT REMOVAL 525 SYS 6 CONCRETE PAVEMENT REMOVAL 146 SYS �3 B 7 CURB, CONCRETE, REMOVAL 149 LFT 8 CLEARING AND GRUBBING 385 SFT 9 LIGHT POLE & FOUNDATION, 1 EA REMOVE =' J�e 10 SIGN, REMOVE & RESET 1 EA 200 Oo 11 CHAIN LINK FENCE, REMOVE 212 LFT 7 � �sc/O ao 12 TEMPORARY INLET PROTECTION 2 EA 4-00 0" 0 1b,*0 '2 13 EARTHWORK 158 CYS 14 COMPACTED AGGREGATE, NO. 53 68 TON S✓� 7g0 HMA SURFACE, 1-1/2" DEPTH, TYPE 19 TON 2j %�' 7 /.Z S� 15 B HMA INTERMEDIATE, 3" DEPTH, 3 TON f v 13 j0 po 16 TYPE B c� 0 16 STANDARD CURB 852 LFT 0 $ X00 17 SIDEWALK, CONCRETE, 4 IN 828 SYS 18 CURB RAMP, CONCRETE 90 SYS 70 °-- 157346 19 PCCP FOR APPROACH, 6 IN 172 SYS 7(p r✓�g 20 HMA PATCHING, TYPE B 122 To 2 00 ORNAMENTAL FENCING - 246 LFT 21 DETENTION BASIN SHEET SIGN W/ LEGEND, 11 SFT 6!5L 22 REFLECTIVE, 0.10 SIGN POST, SUQARE TYPE 2, 18 LFT — !] vb r ob 7 Yb — 23 UNREINFORCED, ANCHOR BASE 24 EVERGREEN TREE, 6-8 HT MINIMUM 3 EA (090 cn 5-v oO 25 ORNAMENTAL TREE, 1-1/2 IN g EA �� y/D CALIPER Version 01/13/2021 Contractor's Bid for Public Works - 7 BID/PROPOSAL CITY OF SOUTH BEND Project Name: 3400 Block S. Michigan Street Improvements Project Number: 120-062r For Bids Due: February 23, 2021 lees_, Contractor Name: PAICnr" Co�uG«r46- SCKJacf�S oAQC Qin 26 V`SEEDED TURF, HYDROMULCH 1,202 SYS 2 Total Amount 27 TREE WATERING SYSTEM g EA 151 �Z a 1 DETENTION BASIN & PLAYGROUND 146 SYS 5-5-9e` J At BASE BID TOTAL Y Al2Z a� a wTG LA Item Description Quantity Unit Unit Price Total Amount No. ORNAMENTAL FENCING — 431 LFT 13� �lo/S gi 1 DETENTION BASIN & PLAYGROUND 146 SYS 5-5-9e` J -0-21 3 TO CONNECT TO EXISTING 6 TON 5T ALTERNATE #1 TOTAL -t' � L5 7.X AI TCCAIATC W! Item Description Quantity Unit Unit Price Total Amount No. BLACK VINYL CHAIN LINK FENCING — 431 LFT po` s6030 1/ s% 1 DETENTION BASIN & PLAYGROUND 146 SYS 5-5-9e` J -0-21 3 TO CONNECT TO EXISTING 6 TON 5T ALTERNATE #2 TOTALR of1, 7 7 — w 1 TGO\I A TC H! Item No. Description Quantity Unit Unit Price Total Amount No. 1 SIDEWALK, CONCRETE, 4 IN — 2 EA po` s6030 a 3 600 �- 1 EXTEND FROM SHERWOOD SOUTH 146 SYS 5-5-9e` J -0-21 3 TO CONNECT TO EXISTING 6 TON 5T 4 SIDEWALK ALONG MAIN STREET 12 TON CO 2 EARTHWORK 30 CYS ZS o� Zl`D 3 SEEDED TURF, HYDROMULCH 140 SYS LD Y46 a .vim ALTERNATE #3 TOTAL r I l Item Description Quantity Unit Unit Price Total Amount No. 1 LIGHT STANDARD, TYPE A 2 EA 11 SG'Oo—' a 3 600 �- 2 ASPHALT PAVEMENT, REMOVE 70 SYD -0-21 3 HMA SURFACE, 1-1/2", TYPE B 6 TON 5T 4 HMA INTERMEDIATE, 3", TYPE B 12 TON CO 5 COMPACTED AGGREGATE 24 TON $(o2i aU7�v coo ALTERNATE #4 TOTAL ' J-� " Version 01/13/2021 Contractor's Bid for Public Works - 8 BID/PROPOSAL CITY OF SOUTH BEND Project Name: 3400 Block S. Michigan Street Improvements Project Number: 120-062 For Bids Due: February 23, 2021 Contractor Name: !/zp A? ,,1 GoNU2FT� S�Q✓l'G%l Bidder (Firm): Address: %I)- �ut�r� g�R✓.zc�'S 0 !P- City/State/zip: [t,u/EaRT DU �i, i Telephone Number: (4-A0�sZr'i!'0�� Byd/ (Signature) (Printed Name of Person Signing) Version 01/13/2021 Contractor's Bid for Public Works - 9 Init. OO ti!AIA Document A31OT'" -2010 CONTRACTOR: SURETY: (Name, legal status and address) (Name, legal status and principal place Premium Concrete Services, Inc. of business) Old Republic Insurance Company This document has important legal 712 Richmond St Brookfield, WI consequences. Consultation with Elkhart, IN 46516 an attorney is encouraged with OWNER: respect to its completion or (Name, legal status and address) modification. City of South Bend, Board of Public Works Any singular reference to 1316 County -City Building, 227 West Jefferson Street Contractor, Surety, Owner or South Bend, IN 46601 other party shall be considered BOND AMOUNT:e ) 5% of Total Bid plural where applicable. Five Percent of the Total Bid ( PROJECT: (Name, location or address, and Project number, if any) 3400 Block S. Michigan Street Improvements; Project No. 120-062 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. 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 herefrom 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 19th day of February 2021 Premium Concrete Services, Inc. (Principal) `/ (Seal) (Wine ) ? - (Title) Old Republic Insurance Company (Surety) (Seal) (Witness)^^}�� (Title) IrSifer L. Cas'Aia, torney in Fact CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured. AIA Document A310- — 2010. Copyright ®1963, 1970 and 2010 by The American Institute of Architects. All rights reserved. WARNING: This AIA® Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA® Document, or any portion of It, may result In severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyrightgaia.org. pB110 OLD REPUBLIC INSURANCE, COMPANY * * * POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That OLD REPUBLIC INSURANCE COMPANY, a Pennsylvania stock insurance corporation, does make, constitute and appoint: NICOLE L BICKNELL, MEGAN E RIESENBERG, MARK EDWARD WOBBE, BARBARA E PEARSON, JENNIFER L KASZNIA, SANDRA L JUNK, WILLIAM J CERNEY, III, WESLEY MANTOOTH, THERESA BURNS, JORDAN SCHEIBER, LISA M THOMAS, FAITH HUNT, OF SOUTH BEND, IN its true and lawful Attorney(s)-in-Fact, with unlimited power and authority for and on behalf of the. Company as surety, to execute and deliver and affix the seal of the Company thereto (if a seal is required), bonds, undertakings, recognizances or other written obligations in the nature thereof, (other than self-insurance workers compensation bonds guaranteeing payment of benefits, asbestos abatement contract bonds, waste management bonds, hazardous waste remediation bonds or black lung bonds) asfollows: - ALL WRITTEN INSTRUMENTS and to bind OLD REPUBLIC INSURANCE COMPANY thereby,. and all of the acts of said Attorneys -in -Fact, pursuant to these. presents; are ratified and confirmed This appointment is made under and by authority. of the board of directors at a meeting on December 10, 2019. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the board of directors of the OLD REPUBLIC INSURANCE COMPANY on December 10, 2019, - RESOLVED FURTHER, that the chairman, president or any vice president of the Company's surely division, in conjunction with the secretary or any assistant secretary of the Company, be and hereby are authorized. and directed to execute and deliver, to such persons as such officers of the Company may deem appropriate; Powers of Attorney in the form presented to and attached to the minutes of this meeting, authorizing such persons to execute and deliver and affix the seal of the Company to bonds, undertakings, recognizances, and suretyship obligations of all kinds, other than ball bonds, bank depository bonds, mortgage deficiency bonds, mortgage guaranty bonds, guarantees of installment paper and note guaranty bonds. The said officers may revoke any Power of Attorney previously granted to any such person. RESOLVED FURTHER, that any bond, undertaking, recognizance, or suretyship obligation shall be valid and binding upon the Company (I) when signed by the chairman, president or any vice president of the Company's surety division and attested and sealed (if a seal be required) by any secretary or assistant secretary; or (ii) when signed by a duly authorized Attorney -in -Fact and sealed with the seal of the Company (if a seal be required), RESOLVED FURTHER, that the signature of any officer designated above, and the seal of the Company, may be affixed by facsimileto any Power of Attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship. obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually affixed. IN WITNESS WHEREOF, OLD REPUBLIC INSURANCE COMPANY has caused these presents to be signed by its proper officer, and its corporate seal to be affixed this 18TH day of FEBRUARY: 2.020. - OLD REPUBLIC INSURANCE COMPANY a`F py Assistant S�Lretar� :( `0 0 <, SEAL r•= y0 Y ,ry.MiY IYY , ..STATE OF WISCONSIN, COUNTY OF. WAUKESHA - SS Vice President On this 18TH day of FEBRUARY, 2020 personally came before me, ALAN PAVLIC and SHEILA M. APPLEGATE to me known to be the individuals and officers of the OLD REPUBLIC INSURANCE COMPANY who executed the above instrument, and they each acknowledged the execution of the same, and being by me duly sworn, did severally depose and say; that they are said officers of the corporation aforesaid, and that the seal affixed to the above instrument is the seal of the corporation, and that said corporate seal and their signatures as such officers were duly affixed and subscribed tothe said instrument by the authority of the board of directors of said organization. - - "" Notary Public My commission expires: 9/28/22 (Expiration of notary commission does not. invalidate this instrument) CERTIFICATE I,. the undersigned, assistant secretary of the OLD REPUBLIC INSURANCE COMPANY, a Pennsylvania corporation, CERTIFY that the foregoing and attached Power of Attorney remains in full force and has not been revoked; and furthermore, that the Resolutions of the board of directors set forth in the Power of Attorney, are now in force.. /; r G/ 45-5314 Signed and sealed at the City of Brookfield 4 h� E a� SEAL jo_ GIBSON INSURANCE AGENCY, INC.. 22851-B POAORI01/2020 WI this day of -e rr� Assistant 5ecre ary 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. 5. Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing your proposal? If not, attach an explanation for the rationale used which would corroborate the prices listed. SECTION III CONTRACTOR'S FINANCIAL STATEMENT Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial statement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to the City of South Bend awarding the contract must be specific enough in detail so that said City of South Bend can make a proper determination of the bidder's capability for completing the project if awarded. Version 01/13/2021 Contractor's Bid for Public Works - 3 Premium Concrete Services, Inc. 712 Richmond Street Elkhart, IN 46516 (574) 264-0196 SECTION I EXPERIENCE QUESTIONAIRE 1) PUBLIC WORKS PROJECTS COMPLETED IN PAST YEAR: CONTRACT AMOUNT COMPLETIO N DATE COMPLETION DATE OWNER $ 1 96,409.45 CURB & SIDEWALK 10/2020 CITY OF SOUTH BEND $ 208,900.00 CURB RAMPS & SIDEWALK 11/2020 CITY OF ELKHART $ 351,308.48 CURB & SIDEWALK 12/2020 CITY OF MISHAWAKA $ 210,400.00 SPEED HUMP INSTALL 10/2020 CITY OF SOUTH BEND 2) PUBLIC WORKS PROJECTS IN PROGRESS: CONTRACT AMOUNT COMPLETIO N DATE OWNER $ 593,590.00 CONCRETE ROAD REPAIR 10/2021 CITY OF GOSHEN +/- $200,000.00 CURB &SIDEWALK 10/2021 CITY OF MISHAWAKA +/- $100,000.00 STREET MATERIALS 10/2021 CITY OF ELKHART 3) HAVE NEVER FAILED TO COMPLETE ANY WORK THAT WAS AWARDED TO US. 4) REFERENCES: a. NISOURCE—MR. LUKE BRADLEY -1039 PENNSYLVANIA AVE SOUTH BEND, IN 46601 b. LOZIER MANUFACTURING —MR. KEN MURR-402 N MAIN MIDDLEBURY, IN 46540 Premium Concrete Services, Inc. 712 Richmond Street Elkhart, IN 46516 (574)264-0196 SECTION II PLAN AND EQUIPMENT QUESTIONAIRE 1) Project: 3400 Block S Michigan St Improvements # 120-062 - Schedule: After given the notice to proceed, Premium Concrete Services, Inc. will review, establish right-of- way, set up traffic control and layout area. We will then contact Indiana 811 to locate all utility lines within construction limits. Next will be inlet protection, removals, excavation, and grading with a 3 -man crew. Then layout with 2 -man crew. Forming and pouring of concrete curb, sidewalk, approaches and ramps will be next with a 5 -man crew. Subs for fencing, lighting and landscaping will follow. HMA patching will be completed throughout the project. Multiple crews may be working at the same time. Process will continue until all concrete and restoration work is complete. Project with be completed on schedule. 2) a) State Barricading Inc.- 24963 US 20 West South Bend, IN 46628 —Traffic Maintenance & Signs b) Acorn Landscaping —3680 W Sample St South Bend, IN 46619 —Top Soil and Sodding. c) Kachur Tree Service, LLC- 316 Fulkerson Rd Niles, MI 49210- Tree Removal. d) Hawk Enterprises —1850 East North St Crown Point, IN 46307 - Electric e) KC Tree, Inc -8913 East US Hwy 20 New Carlisle, IN 46552—Tree Removal f) A-1 Striping Service Inc. — 56825 Spirea Rd. New Carlisle, IN 46552 — Painting g) Milestone Fence LLC -3723 N Home St Mishawaka, IN 46545—Fencing h) Traffic Control Specialists —1810 W Pacific Ave Knox, IN 46534 —Traffic Maintenance & Signs Premium Concrete Services, Inc. Does not require bonding for its subcontractors 3) Will supply list of subcontractors soon after award of project. 4) Equipment use for project: Skid Steer, Mini Excavator, Excavator, Compactor, Roller, Walk -behind Saw, Cut-off Saw, Friction Screed, Dump Truck. Current plan is to used owned equipment, however depending on workload some rental equipment may be necessary. 5) Yes, Premium Concrete Services, Inc. has quotes for all materials in proposal. Ill Com-rr,�-roks r-rtJAIO�1 5T4rr--.P"r�wr- PrLmium Concrete Services, Inc, Elkhart, Indiana Annual Report December 31, 2019 Contents Report of Independent Accountant on Financial Statement ........................ I Financial Statements Statement of Income and Retained Earnings ................................ 2 BalanceSheet ........... - ........ .. ............................. ......................... 3 Statementof Cash Flows ............................................................... 4 Notes to the Financial Statements ................................ ........ ....... 5 - 8 Supplemental Schedules ..... .............................. ........... -.- 9-10 Anthony P. Dibley CPA, P.C. 3414 County Road 6 E Elkhart, Indiana 46514 (574)262-5027 Fax (574) 264-4588 dibleyepa@mapienet.net INDEPENDENT ACCOUNTANT'S REVIEW REPORT To the Board of Directors Premium Concrete Services, Inc. Elkhart, Indiana I have reviewed the accompanying financial statements of Premium Concrete Services, Inc. (an S corporation), which comprise the balance sheet as of December 31, 2019 and 2018, and the related statements of income and retained earnings and cash flows for the years then ended, and the related notes to the financial statements. A review includes primarily applying analytical procedures to management's financial data and making inquiries of company management. A review is substantially less in scope than an audit, the objective of which is the expression of an opinion regarding the financial statements as a whole. Accordingly, I do not express such an opinion. Management's Responsibility for the Financial Statements Management is responsible for the preparation and fair presentation of these financial statements in accordance with accounting principles generally accepted in the United States of America; this includes the design, Implementation, and maintenance of internal control relevant to the preparation and fair presentation of financial statements that are free from material misstatement whether due to fraud or error. Accountant's Responsibility My responsibility is to conduct the review engagement in accordance with Statements on Standards for Accounting and Review Services promulgated by the Accounting and Review Services Committee of the AICPA. Those standards require me to perform procedures to obtain limited assurance as a basis for reporting whether I am aware of any material modifications that should be made to the financial statements for them to be In accordance with accounting principles generally accepted in the United States of America. I believe that the results of my procedures provide a reasonable basis for my conclusion. Accountant's Conclusion Based on my review, I am not aware of any material modifications that should be made to the accompanying financial statements in order for them to be in accordance with accounting principles generally accepted in the United States of America. Supplementary Information The supplementary Information included in Schedules I and 11 is presented for purposes of additional analysis and is not a required part of the basic financial statements. The information is the representation of management. I have reviewed the information and, based on my review, I am not aware of any material modifications that should be made to the information in order for It to be in accordance with accounting principles generally accepted In the United States of America. I have not audited the information and, accordingly, do not express an opinion on such Information. nk%o G I°4 Anthony Dibley, CPA, P, Elkhart, Indiana February 4, 2020 PREMIUM CONCRETE SERVICES, INC. NOTES TO THE FINANCIAL STATEMENTS December 31, 2019 and 2018 NOTE 1 —SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES NATURE OF BUSINESS Premium Concrete Services, Inc. is a concrete contractor engaged in commercial and residential concrete construction activities in northern Indiana. The work is performed under various types of agreements including fixed price and cost type arrangements. Concentration of risk is minimal due to the diversity of clients' industries and the non-recurring nature of contracts. ACCOUNTING METHOD FOR RECORDING PROFITS OR LOSSES ON CONTRACTS Profits on contracts are recorded on the bases of the Company's estimates of the percentage of completion of individual contracts, commencing when progress is sufficient to estimate final results with reasonable accuracy. That portion of the total contract price is accrued which is allocable, on the bases of the Company's estimates of the percentage of completion, to contract expenditures incurred and work performed. As these contracts extend over one or more years, revisions in cost and profit estimates during the course of the work are reflected in the accounting period in which the facts requiring the revision become known. At the time a contract loss becomes known, the entire amount of the estimated ultimate loss on the contract is accrued. CASH EQUIVALENTS For purposes of the statement of cash flows, the Company considers all highly liquid debt instruments purchased with a maturity of three months or less to be cash equivalents. ACCOUNTS RECEIVABLE Trade accounts receivable are stated at cost less an allowance for doubtful accounts. Management establishes an allowance for uncollectible accounts based on past collection experience and by analyzing each account Independently to assess collectability and the need for an allowance. PREMIUM CONCRETE SERVICES, INC, NOTES TO THE FINANCIAL STATEMENTS December 31, 2019 and 2018 PROPERTY AND EQUIPMENT AND DEPRECIATION Assets are recorded at cost. Depreciation is provided over the estimated useful lives of the assets using the straight-line method. Upon disposal or retirement of any item of property, the cost and related accumulated depreciation are removed from the respective accounts. Any gain or loss from other disposals is included in operations. Maintenance and repairs are charged to operations; renewals and betterments are capitalized. ADVERTISING The Company expenses advertising costs as they are incurred, The total advertising costs expensed in 2019 and 2018 was $27,437 and $26,471, respectively. USE OF ESTIMATES IN THE PREPARATION OF FINANCIAL STATEMENTS The preparation of financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates. NOTE 2 — PROVISION FOR INCOME TAXES Effective November 24, 2004, the Company, with the consent of its shareholders, elected to have its income taxed under Section 1362 of the Internal Revenue Code and similar sections of state income tax laws. These sections provide that, in lieu of corporate income taxes, the shareholders are taxed on their proportionate share of the Company's taxable income. The federal and state income tax returns of the Company for 2016, 2017, and 2016 are subject to examination by the IRS and state taxing authorities, generally for three years after they were filed. When theprospeetive Contractor is tillable to certl�� to any of lire 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:130LAA)A- ) ) SS: El -M Ifi Al T 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 Contractor, its successor or its affiliate, is a financial institution that extends twenty million dollars ($20,000,000) or more in credit to another person for forty-five (45) days or more, if that person will (i) use the credit to provides goods and services in the energy sector in Iran; and (ii) at the time the financial institution extends credit, is a person identified on list published by the Indiana Department of Administration. Version 01/13/2021 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, orjoint 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).1 hereby certify that I and all subcontractors employed by me for this project will use steel products or foundry products made in the United States on this project if awarded. I understand I have an affirmative duty to notify the City in my bid that my proposal does not include the use of steel products or foundry products made in the United States. I understand it is my sole obligation and responsibility to provide ajustification to the City, subject to review and approval, why the cost of United States made steel or foundry products is unreasonable. Prior to award and upon submission of bid which does not use steel products or foundry products made in the United States, the City, through its director of public works, shall make a determination if the price of United States made steel or foundry is unreasonable. I understand that violations hereunder Version 01/13/2021 Contractor's Bid for Public Works - 5 may result in forfeiture of contractual payments. **r 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 r 3P day of _R&, 20 a1 �(LC=rKxupl GvnkJZf7��RUrcL`5 TNt Contractor/Bidder (Firm) Signature of Contractor/Bidder or Its Agent �o6 65rxm,� 7�d crl .W,46—,4 Printed Name and Title RD Subscribed and sworn to before me this a3 day of 20y2( My Commission Expires bd , NoJay Public County of Residence El-i�iA� J O NOTARY PUBLIC R SEAL ELKHART COUNTY, STATE OF INDIANA MY COMMISSION EXPIRES FEBRUARY 12, f COMMISSION NO.710399 Version 01/13/2021 Contractor's Bid for Public Works - 6 This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MBE participation. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the MBE qualifications. Project Number: Bidder: 120-062 Project Name: 3400 Block S. Michigan street improvements ja9,EwtE4nt CD1ICRfi7S- JT.GES Total Bid Amount: "373F905' MBE Goal: 2.6% Page of Name & Address of MBE Primary Contact Person (Name/Telephone) Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of MBE Component CITY OF SOUTH BENDMINORITY AND AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MWBE-1.0 se MWBE UTILIZATION PLAN This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MBE participation. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the MBE qualifications. Project Number: Bidder: 120-062 Project Name: 3400 Block S. Michigan street improvements ja9,EwtE4nt CD1ICRfi7S- JT.GES Total Bid Amount: "373F905' MBE Goal: 2.6% Page of Name & Address of MBE Primary Contact Person (Name/Telephone) Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of MBE Component Percentage of Total Bid/Proposal Submitted by: a� a &R ��I 1;�3/2 Print Name Signa ure Date Version 01/13/2021 Contractor's Bid for Public Works - 10 ot�urx ef!. CITY OF SOUTH BEND ° i MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN r FORM MWBE-1.0.i MWBE UTILIZATION PLAN This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving WBE participation. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the WBE qualifications. Project Number: 120-062 Project Name: 3400 Block 5. Mi Bidder: FAa^XuA fen)!2&?� SGkVS��S Total Bid Amount: 4 P,31 go 9 WBE Goal: 4.7% Page of Name & Address of WBE Primary Contact Person (Name/Telephone) Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of WBE Component Percentage of Total Bid/Pro osal q�k E1JT£lLQlCSS�s-,4aa O44ak- fSE»iod7E 5=G R�F Oa y s% / ANOR?coJ ;i q, ��r { 1650 5*5T � 0, r/, �t 15� �p�o�'809D L£� � LSGHT rY GVa+t OoZa7 2n1 y6307 5578 n.4RO TAAFFi[- &WrXDL �J. PrtcrFSG 3AAXY 'r=,,,t,4 14AXrJTEx0Aavc6 Of %4'fFFXC- `�o 3,6< l$Iv -7-7;Z-7-7;Z_700 ( / K,70X I T -J �{f9S3 y Submitted by: Rata j35-6K&,e— 2z,;R-- Print Name Signature Date Version 01/13/2021 Contractor's Bid for Public Works - 11 CITY OF SOUTH BEND e�1 MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN x1 j FORM MWBE-2.0 urs 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 MWBE participation. Project Number: Project Name: Bidder: Contact Person: Address: City: Email: 120-062 Date: n2/.23/-�?I 3400 Block S Michigan Street Improvements ✓j -'C: Sy 906 Telephone: 7/eZ t t419#KT- State: -V0 zip: f?AB�ck'�!� @ Q/{��Zcrnr Gda'cR�r>r oa?L-X'NJ_.�ya� To determine whether a bidder has demonstrated good faith efforts to reach the MWBE utilization goals set forth in the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or commissions, REQ1IRF At L of the following Good Faith Efforts as listed in the table below*: Version 01/13/2021 Contractor's Bid for Public Works - 12 EVIDENCE OF GOOD FAITH EFFORTS MWBE LIST(S): The bidder reviewed 1) the City of South Bend's Minority and Women Business Enterprise Inclusion Program Plan; 2) the list of certified MWBEs provided by the City; and 3) the Indiana Department of Administration list of Minority and Women Owned Businesses (both certified and non - certified) found at: htt 1/vvvvw.in.gov/idoa/. GOOD FAITH EFFORTS TO OBTAIN MWBE PARTICIPATION The bidder shall initial each item below, as evidence of its good faith efforts to obtain MWBE participation in the awarded contract. I affirm that I reviewed the City of South Bend's Minority and Women Business Enterprise Inclusion Program Plan and the Indiana Department of Administration's certified list of Indiana Minority and Women Business Enterprises, found on their website (http://www.in.govlidoa). I affirm that I have made good faith efforts to select portions of the contract work to be performed by MWBEs, including, where appropriate, breaking out contract work items into economically feasible units to facilitate MWBE participation. I affirm that I have made good faith efforts to solicit through all reasonable and available means the interest of all MWBEs in the scopes of work of the contract. I affirm that I attended all pre-bid meetings scheduled by the City of South Bend to inform MWBEs of contracting and subcontracting opportunities. I affirm that I advertised in general circulation and/or trade association publications concerning subcontract opportunities and allowed MWBEs reasonable time to respond to such advertisements. I affirm that I performed any and all necessary steps to provide written notices in a manner reasonably calculated to inform MWBEs of subcontracting opportunities and allowed sufficient time for MWBEs to participate effectively. I affirm that I followed up on initial solicitations with interested MWBEs. I affirm that I negotiated with interested MWBEs in good faith, including providing such -� MWBEs with adequate information about the plans, specifications and other requirements of the subcontract. I affirm that I have made good faith efforts to assist interested MWBEs in obtaining bonding, lines of credit, or insurance as required by the City or the bidder, where appropriate. Version 01/13/2021 Contractor's Bid for Public Works - 12 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MWBE-2.0 EVIDENCE OF GOOD FAITH EFFORTS O SOU I110EryO U 7 !psi, *Proper demonstration of Good Faith Efforts requires your initials next to au of the above boxes. r ny omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of South Bend reserves the right to request additional information. Version 01/13/2021 Contractor's Bid for Public Works - 13 I affirm that I have made good faith efforts to assist interested MWBEs in obtaining necessary equipment, supplies, materials, or related assistances or services, where appropriate. I affirm that I did not reject any MWBEs as unqualified without sound business reasons based on a thorough investigation of their capabilities. CONTRACT RECORDS: The bidder has maintained the following records for each MWBE 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 MWBE was unqualified to perform the job. *Proper demonstration of Good Faith Efforts requires your initials next to au of the above boxes. r ny omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of South Bend reserves the right to request additional information. Version 01/13/2021 Contractor's Bid for Public Works - 13 ,o�uix ppry CITY OF SOUTH BEND e' MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN \ y Ja FORM MWBE-2.1 Oxus _ MWBE CONTACTED This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring Good Faith Efforts to contact MBEs. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the MBE qualifications. Attach additional pages If necessary. PAGE OF Project Number: 120-062 MBE Participation Goal 2.6% Project Name: 3400 Block S Michigan Street Improvements Bidder: REi+7Funr Ctcf67� S�RJrcES By. � 45rzrn�toR ORar�cr N-4, �� ®7 �3�2 (Signature) (Title) (Date) MBE Firm Owner or Contact at MBE Firm Telephone: Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBE FIRM: MBE Firm Owner or Contact at MBE Firm Telephone: Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBE FIRM: Version 01/13/2021 Contractor's Bid for Public Works - 14 OF SpUTH deryGi CITY OF SOUTH BEND ' MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN z Ir j FORM MWBE-2.1 ds MWBE CONTACTED This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring Good Faith Efforts to contact WBEs. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the WBE qualifications. Attach additional pages if necessary. PAGE OF Project Number: 120-062 WBE Participation Goal 4.7% Project Name: 3400 Block S Michigan Street Improvements Bidder: -,--7 By: NGAS-Ya- WBE Firm #,#t,) K r. At7;E2 PRS SES _N L Owner or Contact at WBE Firm -�370-,4nJ V /o6/tnl K Telephone: Q11)(? -8656 Fax: /f 662 -So Email: NA1 " ��Aa_Jtr-SNL•Cor+1 TYPE OF WORK SOLICITED FOR THIS PROJECT: SZGNA&E V- �L�cTRS� RESULTS OF CONTACT WITH THE WBE FIRM: Wsa- U7-7t..zZF1 XF /W44,0,C/9 WBE Firm `T/L4FFrC, CONTROL S��4YI3[,�STS Owner or Contact at WBE Firm 'TRAM Y 'TRS k R Telephone: (`$ y)' 7-2 -706 Z Fax: 5,07V -'200.2, Email TRAc� Y TGS�� f1+^t5T5. pI$'i TYPE OF WORK SOLICITED FOR THIS PROJECT: 1yJ*XjU-r&,V *,Ve E of TRAFFsC- RESULTS OF CONTACT WITH THE WBE FIRM: G' 7!u- bI T-tL zE -YC /¢W-19,19EQ Version 01/13/2021 Contractor's Bid for Public Works - 15 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: February 19 2021 To: All Planholders From Anne Fuchs, Clerk, Board of Public Works Subject Addendum Number: 1 Project Name: 3400 Block S Michigan Street Improvements Project No.: 120-062 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: 21 /cF 12 l 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: Authorized Signature: Date: )/,I/ 3.02 SHEET 4, DIMENSIONAL PLAN 1. REPLACE sheet with attached plan sheet. Revisions to plans include an added note for construction of the concrete drive approaches and revisions to right-of-way asphalt patching. 3.03 SHEET 6, GRADING PLAN DETAILS 1. REPLACE sheet with attached plan sheet. Revisions to plans include a revised note stating the minimum width of a curb ramp is 5'-0". 3.04 SHEET 9, LANDSCAPE PLAN, NOTES, AND DETAILS 1. REPLACE sheet with attached plan sheet. Revisions to plans the removal of site irrigation notes, and a revised tree planting detail including irrigation water bags. 3.05 SHEET 11, MISCELLANEOUS CONSTRUCTION DETAILS I 1. REPLACE sheet with attached plan sheet. Revisions include the removal of wire mesh from the 6 IN concrete pavement detail and a revised modified combination curb detail. 3.06 SHEET 14, MAINTENANCE OF TRAFFIC 1. REPLACE sheet with attached plan sheet. Revisions to plan include the entire street closure of Dean Street and Sherwood Avenue. END OF ADDENDUM JONES PETRIE RAFINSKI _„111111 No. LA2130DO12 ? o STATE OF Andrew Cunningham, PLA i,' ' ,/NDIANP Landscape Architect "''f"jPEi11%01%' m shall Acknowledged by:�/ Signature of Bidder N 2 Date 3400 Block S. Michigan Street Improvements Addendum #1 February 19, 2021 Page 4 CITY OF SOUTH BEND JAMES MUELLER, MAYOR DEPARTMENT OF PUBLIC WORKS ERIC HORVATH, DIRECTOR May 29, 2020 Janee Towner Premium Concrete Services, Inc. janee@premiumconcreteonline.com RE: Pre -Qualification Verification Dear Ms. Towner: 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, Liz Horvath, Permit Manager CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK RESPONSIBLE BIDDER CHECKLIST Project Name 3400 Block S. Michigan Street Improvements Project No. 120-062 For Bids Due February 23, 2021 Contractor Name: hnJG1q2_Crr 5, -a1 -114c1-5 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 31s1 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 01/13/2021 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: 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 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 01/13/2021 General Conditions - 7 PRE -QUALIFIED BIDDER CHECKLIST (a) Acknowled ments: (i) 7 By checking this box, I hereby acknowledge that I am a pre -qualified bidder with the City of South Bend and that I have met the pre -qualification requirements within the last twelve (12) months. A copy of my Pre -Qualification verification letter is attached. (ii) By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided by me, and may also conduct random inquiries of my current and prior customers. (b) Attachment : (i) _7 Indiana Secretary of State's on-line records (ie. Business verification) dated within sixty (60) days of the submission of said document showing that business is in existence, current with the Indiana Secretary of State's Business Entity Report, and eligible for a certificate of good standing. (Not applicable to individuals, sole proprietors or partnerships). (ii) — Statement on staffing capabilities, including labor sources. This statement indicates and ensures I have sufficient employees on staff to complete the work. It outlines how I intend to meet the staffing needs of the work. (iii)/ List of projects of similar size and scope of work performed in all areas, including / the State of Indiana, within the last three (3) years. (iv) _✓✓✓ For every project, submit evidence of participation in apprenticeship and training programs, applicable to the work to be performed on the project, which are approved by and registered with the United States Department of Labor's Office of Apprenticeship, or its successor organization. Version 01/13/2021 General Conditions - 8 II. PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED) (a) Acknowledgements: (i) _ By checking this box. I hereby acknowledge that I am not apre-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) _ (iii) 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) (iv) years. 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 (vii) Apprenticeship, or its successor organization. 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 01/13/2021 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: 21 3 ( '�? (Signe (Print Name Here) QR£e>rsuY, GdAkCAOrAC 5�4✓i-e-R (Name of Company) 2/2 9r6,/,Z'77oyO 57-- (Address of Company) rl- (City) -�0 (State) (Telephone Number) Version 01/13/2021 General Conditions - 10 BUSINESS INFORMATION CONNIE LAWSON INDIANA SECRETARY OF STATE 04/30/2020 02:37 PM Business Name: PREMIUM CONCRETE SERVICI,S, INC, Business ID: 2004120100105 Eulity Type: Domestic Por -Profit Corporation Business Status: Active Creation Date: 11/24/2004 Inactive Dale: Principal Office Address: 712 RICHMOND ST, Eld<HART, IN, Expiration Date: Perpetual 46516, LISA Jurisdiction of Formation: Indimta Business Entity Report Dae 11/70/2020 Date: Years Due: Title Name Address President Becky L. Yeakey 712 Riclmrond Street, Elkhart, IN, 46516, USA Vice President Max A. Ycakuy 712 Richmond Street, Elkhart, IN, 46516, USA Name Title Address MAX A. YEAKEY Incorporator 1737 CRABTREE LANE, ELKHART, IN, 46514, USA Type: Individual Name: MAX A. YEAKEY Address: 712 Richmond Street, GB<hmtt, IN, 46516, USA i° Premium Concrete Services, Inc 712 Richmond Street Elkhart, IN 46516 574-264-0196 fax 574-266-5392 04/30/2020 To Whom it may concern, Premium Concrete Services, Inc. currently employs 24 people, 4 of which are field supervisors, 7 concrete finishers, 10 laborers and 3 heavy equipment operators. We are signatory to the local Cement Masons, Laborers and Operator's unions through which extra employees can be pulled from when needed. Max Yeakey VP R-39514 LaSalle & Marquette South Bend INDOT $ 210,779.59 Sldewalk, ADAcompliant 1902 1-40046-A Traffic Signals Ft. Wayne INDOT $ 199,735,00 Curb, curb & gutter, sidewalks, HMA patching, I CCP patching, curb ramp, 1914 detectable warning surfaces South Bend Waterworks South Bend City of South Bend $ 79,121.00 Various concrete/asphalt utility repair wol k 1936 R-40913 Howe, IN SR 12 Howe INDOT $ 57,989.85 Concrete A substructure, Concrete 0 footings, reinforcing bars epoxy coated. 1929 City of Elkhart Various Elkhart City of Elkhart $ 70,171.35 Various concrete curb, sidewail< & sitework 1904 riffs 1NA WBOREMOTTRAWNG TRUSrTFUN.D Vrnvit A Pi;I,e 5eercheF9r..$prasurer Jei'fyJ BoA Chris J, Guerrero Rirlry Aensorr, Jr. Ramon ddeni-lora, Jr. .Robei•13.. Mright P.0.I3oti 75A - Tiedfird, Sn�3iaux 47/57.1 (1712) 2.79..9751 IVlay 20, 2019 To Whom It Muy Concern; SPA21 Coa;dey, Dhwefor .701111 P. Brown Chainitav !telly Abel Brad Dreibelbia Man Afeye-r Aw uriemuci kftfll (M)279,564S Phis latfea is to eonfr111 ttwt "Preiuium Conoretc Srr<rires, lac. ° is ssi,gna my confrAe'Lor ill good . standing with the lilehana )_,ahold:s' Trainiou Trost fund, The above inentioaed rompauy k n prntic;ipatit in the Joint !Apprenticeship tint! Ttaii h Committee throu,� this Union slid has heen on active participant in good standing fof each of file past five plus ronsecntivo je<uns, and is currently eligible to ore our apprut(ices on 9 project. Furtaier, our and)o1Zstio1l's program is approved by the 118. Veterans Administration to participate in die G1 cdoaationztt henofits program, A copy of our approval letters are atfaehed alo.ag with file collective bargaining agrccnicnl Si, die ratios of .Journey workers Co ,Apprcahces; which is one (1) Appe ntico for every five (5) .tourney Workers mcl thereaftesf: naay trot Copley more (lint ( I ) Appreotige 1:or every (S) ,!entity workers. Sincerely r") SeaaCoalceyr f f2irrchn' S('.:dc u1,lnrv. irvdinruFlrlGnr•nl.rtr ciiir brg. nr g, Ziff ��1� �� Lt��'�'h`�Y�Sz G-5yt 'c�s�iY+&� `�C��bam- I� C Tertifficate TF9IANa LdIWRF17S TR_TZ\�?G T_rUST FUND for the _=ade _ia_si£icat.LorL of CONSTUCTPGid CR^TT 1.,BCP.ER • i' par � `� % s��J=t. ✓ 1'��i tom..'<: J i� .1L Lrvre�.ryiVfl)�'JLowe a K� dG/} p� J:. sem* ssww!.'azv so ^lY �,^3%"ic % a� So M 3 oy 23 .. J % December L4= 5995 oll "T'aZ, 0-3525 my "&. &. S,v. STATE OF INDIANS DrPAR i MEN s OF VETERANS AFFAIRS STATE APPROVING AGENCY lt) N 1 402 WEST WASHIh)GION STREET ROOM W409 INDIANAPOLIS, INDIANA 462011-V38 kro ny Brewer Apprunficeibip Coordinator Indiana Laborom T`rtining Trust l?LuId. -Appeeuticbship 439 Patton Hill Rd.. Lse+:dford, IN 47421 Dear .Teramy 13revver, Eric Holcomb, Governor Jamas M. Brown, director Jauttaty 9, 2019 Thiswl'Il arf uocvle gereoeipCof7urunpda.Ccrl vla ;:aeai.rldi I'lie,,construdinre peo,gram offered by lnidiana Nibnren's Trnitrhig Trust Fuud-r\pprentirrahi:p, `!he Shde A.ppruviug Agoucy has reviewed the docninentsis listen below: woge FkAe, Corastrumtion Cr'ait.. I,aboic-w W-ekCALITY CODE: ADM'! (4 lb ilre best of mq 1Crrowlc lge (tdia �a T aiUot:ers Tttulliat T -Hast I1md-F ppreni'ire It 7 does .uot: ntilizo erroue )I or misleading adve-liseeneut, oitlrer: by actual ;I:ateraeut, oinission, or intimatiou. %t is oudmiooid by ➢rdiona Laborers Training `IS:usl l=Lmd Appronticesl p that they x'ili rnaintam a. complete, record of all advortisin, utilized by or on boh.:ilt of the Tiadjana Laborers Tfalit ig't3rost Iirrad-Apprenticeship in regards to their irailliag prograsts d'uratg'the, preoedurg 12 rnonilbs. huliana Laborers T'rabr3rrg Dust Ftrrtd-Apprepiiceship`s advertising will be availoblo for revievr by ony and flit fu tie supervisory visits by Che SAA,, or the US', Deparlment of Veteran Al3iur>. Please Rewiery fdre cnthe paclmt £or aontz,ot and nr"eura.oy. Approval is granted panvrant f:o Che prrresi0IWI of 1'iil,;a. 333, L].S. Code 3637, wii6 an efl'erti'ae date of April 1, MIS, 1£you leave airy, questi9n5, plemso £bel fieo, fo give me a crdl at 31'7-23'2,-3916 or email ria at gria7in(;d-aaugov. Thank you fo.r n+lra:f ytat do Proof Vet(wam., anal Dave a great day! ,Sirvxa:r"ly> Taniqua Clri111u Program Div ctoc State Approvhig AgmwY Cc: VARO/FT.,R STATE R� INDIANA DEPAURIENT OF VEMRANS AFFAIRS STATE APPI'WVING AGENCY 402 WEST WASHINGTON STREET ROOM W-4133 INDIANAPOLIS, INDIANA 46204-2733 fermi y Tat ewe, Apprenticeship Coordbmtm Luliana Labmer;s TrafLziag,'frust Fulyd-7�pliseJuicesirip 139 f atl:on Bill Rd. 13edtord, m 47471 Dear Je; elny 13eevaer, Eric ; lolcomb, Govemor _ Jamas MI. taro, Uirecfor fan'aary 9, 2019 Tile. lnrtlann Male Approving Agtaicy canclu ted u s.grervisnry visit on 01/3/2.014 ItTndiama f a.bomn--rah-dag Trust '1116 pulipwo ofthe visit Was to providet.rellting to the Certifying Officials and review onrotbne'al cotfrlicatiatt recordrrteutiott avid repodiog procedures. T1ne orgeaiza.Sinn dernonsirnted proper record maintenance rr32 reemd maiatenauce stud rcpordtag La Octechrres. bntiu;; the visit, We diseussml the importance of reporting boars oil a nooaUd,y b'a'sis, Rood rera;d (ceepirav 1:2o uciques, moil iaaw to report a leave o f absence or rol,10 ,tion via VA Form 22-1999b. We also upciated tine Certb;yirig Ofiiciaisvia VA Bond 22-8794, wosk.processes, Anil wage son is, 1f 51011 need any assist Alice or have rnny cgtestions regarding'tlnis te0bItieal visit plea e c0lilaot me diredly at tgri£firtgldva,irr.gav or (3 17) 232-3916. T_'Islok you. for the roustesy extenried dtu'ing lnTy visit. Tyre education and Iminin; opportunities ghat your organization conlinnes'to )7rovide vetol'alls and their dependents are appreciated. Siac„rredy, ,t•aing( m'01dffin Program Dhoctor Phone (117)-2311-6062 17)1 Prcc(600)t400-4N20 pw(317)�234•9744 STATE" OF INDIANA UEPARYNIrN-f CIT= VC-TCRANS AFFAIRS STAT'F APPROVING AGENCY ,Fo2 Wr-ST WASHINGTON STREF_I ROOM W-48CJ INDIANAPOLIS. INDIANA 46204-2733 Jeremy Brewer App oraticeslup CnOrrlitnit:01' Indiana Labm ons TTaining Trust Fund Alrprenticeship 439 Yatton Hill Rd. r3cd£ord, N 47421 Dear Jeremy Prower, G is Holcomb, Governor _ James M. [crown, Director January 9, 2019 chis will arlcnotidcdgo rce(,ilxt nryour mvisnd Mork ip)-ocesse;;'ter the, Coustrue itoll CTrvP: Labol'es _prog:a,xr tiffered aY ii0osiu Bnrrgy, located itt P>edford, Lnrlima. The Sta Approving ,&gency. sins ,-evi.ewurl talo doculool It as listed below/: i)iF_1i)IEICG3'(2dl,fLTAlV4.......T ..3 M'1Vi dZa __ l`C8I Qf A➢J+i.. i;Orasl:.t•ttic oil CTT ft.Labrvel' FACILUCY CODE: 30004114 4-o0(l-•7800 h.uurt; /f7-2061.00 To tho best of n'ty kuoaded9e lildiana Laborers Tr%rin ng'Trust Fund-tlpprentiresLip does not utilize otroi.mous or misleading acheviisement, either by achlal 2;btfemmxt, omission, 01! [Ribanatiall. It is tuulc-mtood by 111dinoa. Laborers Ttaitiiug Ttt7st I'wxd-Aplirrn[icesl p that. I:hep Vrill maintain a. complete reaofd' of all advettisutg aril zed by or on beholl' of the Company in reg,au1s to titch Irain ug Programs during tale precediug 17, rnonfhs. The company's adveitising will be available for revi.ew by way and all fatm'c Supervisory visits by titr, Ss'LA, or the US, Departmoo4 of Vei:erau Affah;S. Tans approval ho fnat<, pruarranl to and unlet flus provisions of'Ti$es 3S, US, Code 3687, with an affective, (late ot'jaullavy 8,2019. if you have auy (Irl"tious, please oanfacl: ane x1.31'7-232-991 G. uhice:rely, Taniqurr Griffin Yro -irecfur Sante, Approvht,(; A.genr y Jr,:VA13Z1MLR 'rhm,, (3I'7)-'234-6062 'full tTrue(2rlip-400-4.i1?0 Pax (317)-''-.34-6'744 r.PPREM?3i:ESHiP YEAIRLY Slid w,d ,.R'f 2017 C?.-L=�fn::!A�p jLl'3 S- f L � ?tiTJt�e S�sZPET.iI�25 !1 � sa ula IlYl I y_0 1 0 10 7 I 0 25 LU #61 1E. s 2" ' 11 `1 '—� '` I.F '133 �— zi 27 13 0 x_ 208 C LU E _ .8 et J `d 5 n ��_ f L `� F 4T o f � 4 0 k� 6o — j�Jq� f' ° e 1 1 z7n fit 17 111 - 0 � 94 ' i' .._.. ,...,3L `J_a On li �ad u G d ! 0� 9i 30 �I 7 x- [ _L' #661 83 'd ' d 0 0 J #S45 Ml 13 52 1 �; 0 � 0 � �' 198 S6 35 i = � 0 I 91 -' K U V741 8 3 �C f 0 o ), 49 i,. 26 4 1 L d '_ 73 I� "4s t e $1'($2 �73 —��=.' 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SUVlI,;1AF�y 2015 'ac 41,p T�r=m ii�, �I :It d - LN-', 4t13, TNI TEN 4 th a - 95% - pl 1005/1, sib I u *Il;'i ligz, A7 If q 113 4 so 2Ili, 12 A7 14 I P 27 1 35 i0 4 y au o s, 13 3 4 4e I sli� J L1.�a74, 52 3.3 0 is j 75 S5 13 7 iO"z Fy 54a 51 104 i 0 0 102 23 133 LU t-:741 59 Q 13 Lid -:7 95 0 2 u #.! s" 1 4 E 0 Z 9 is 3 3 0 63 TOITALS'4 7 r,! Az of December 3,1. 2015 As cf Dc�mbv- 31. 201 -, Ul 4741 lli S Y 0U' —117� AC= VSI-vBMO D INM ��=00 SRDPFMC-D ' " -,d CSD vtz� Mr, 1: P—,z Lr9 CAL# TI-ImmPmax Fi TERM rw[6, j 35-111. 103, 1 IM% 2 0 G 0 0 40' r n, 14 G ao S2 i 35 so m ss pzC-11 21 22y f5 i es LIU is. -IZQJll�2 S2 213 20 ?2 LU =4 26 47 2; 41 9 V. 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Masons, Apprenticeship Coordinator Local Union /1692 I o Whrz:.rnn It May Concern: A ��EgS SND R �j�yl'a.A L4 � ° z t onowwn ' 1864 ^f 'Gy' Uw Phone: (219) 707.7767 Email: Uristoff@plcrolocal692.org May 16, 20 PreYniurn Concrote Ser ces Inc, Is a signai:ory coniractor moth) tocal 692 and participates in the Plasterers of Cement Masons Apprevu.jceslllp Training Program, I may he reached at (219) 7074767 1 additiorral itifc7rrnation is nn r1ed. Thank you, Brian Kristoff Apprentice Coordinator Plasterers & Cement Masons l_ouiSilOna Street ° Merr! Iville, Indiana 4 64 10 Of OfOf.PLz MIt. 0)3''",Ad_69P,c)P� t. T 9 ro. 'N+f24, °5' �� aW.,i� �q.tfo n''"i "h 1h :IF�` ".' �F3-xr-�^'NA m+ f' '- A!� kF- ei 4r ii f t}' -` - y,, y a'ak: ^`' s d i i i W-' ro-n, az h. .»- ..�,;y.^-y�-�E-ia.^b^,�?t �.,t�- .r„@y"a e-.u.:.€a- 2, �b-.z<:.�"�. �nf'-,--��.',�. P' �•`.�' F S-li'y:. 4.'.S - CEMENT 1�1 ,!Re: uS.7 �Y` q :a.i^-`: G., lw� .S' w -!'s. iV_��. L- h'^t:FLk'i��LLtf 'd t®Y.ir, :E`<s�Yl't �7r�l =Or THE TRADE C_ASS!P'.CAT:ONS: CE,44EM'7MASON: PLASTERE' _ rry ✓'; i__�.: v_.il,j,"i v✓.3L —.. .. .�'./,)e' i;4.�2�n-.l�.''.�. _.�'i?� L.i'+?L_Tt'.'.-1 ✓uL^ .Z7• iwi�wv 4'<r. MAY 22. 1995 Da.. t"C,se? :\fw71FE'I beT , 2018 by l o96'r%002 ._..._ G