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HomeMy WebLinkAboutOpening of Quotes - Charles Martin Parking Lot Proj No. 120-051R - Milestone Contractors North, Inc.CITY OF SOUTH BEND, INDIANA CONTRACTOR'S QUOTE FOR PUBLIC WORK PROJECT NAME: PROJECT NO. QUOTES DUE Charles Martin Parking Lot 120-051 R 3/23/2021, 9:00am (local time) to bpwbids@southbendin.gov (Must be completed for all quotes. Please type or print) Date: 3/23/2021 Address: 24358 SR 23 City/State/Zip: South Bend, IN 46614 Firm: Milestone Contractors North. Inc. Telephone Number: 574 } 288-4811 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: Charles Martin Parking Lot — asphalt repairs the City of South Bend, Indiana, in accordance with plans and specifications prepared by: The City of South Bend, Department of Public Works and dated 8/28/2020 for the sum of (enter the Total Quote as shown on the Proposal) y two thousand nine hundred fifty two dollars and zero cents ($ 62,952.00 ] (Enter Sum of Total Quote plus Alternates shown on Proposal) (Numerical) If alternative quotes 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 f units must be the same as that shown in the original contract if accepted by the City of South Bend. Iftk6,Qdbtei to be awarded on a unit basis, the itemization of the units shall be shown on a separate attachme ' `m00%') 011111111.#., racto t6l.. L.............,jo `SRP 0 RgTF.�� ; S The above quo this this Subject to the following conditions: BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Gary A. Gilot, Member Joseph R. Molnar, Member By / (Signature) Dustin Hilary, VP of South Bend Area ACCEPTANCE day of (Printed Name of Person Signing) Jordan V. Gathers, Member Attest: Anne Fuchs, Clerk 20 Version 2/14/2020 Page - 8 Public Works Quote When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit. CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON-DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS (Must be completed for all quotes and bids. Please type or print) STATE OF Indiana ) ) SS: St. Joseph COUNTY ) The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury that: 1. Contractor has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and 2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency; and 3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investment activities in Iran. a. For purposes of this Certification, "Iran" means the government of Iran and any agency or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from time -to -time. b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor is engaged in investment activities in Iran if either: i. Contractor, its successor or its affiliate, provides goods or services of twenty million dollars ($20,000,000) or more in value in the energy sector of Iran; or ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty million dollars ($20,000,000) or more in credit to another person for forty-five (45) days or more, if that person will (i) use the credit to provides goods and services in the energy sector in Iran; and (ii) at the time the financial institution extends credit, is a person identified on list published by the Indiana Department of Administration. 4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the Contractor subsequently learns is an unauthorized Version 2/14/2020 Page - 9 Public Works Quote 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, firms, partnerships, corporations, associations, or joint venturers awarded a contract by the City of South Bend through its agencies, boards, or commissions shall not discriminate against any employee or applicant for employment in the performance of a City contract with respect to hire, tenure, terms, conditions, or privileges of employment, or any matter directly or indirectly related to employment because of race, sex, religion, color, national origin, ancestry, age, gender expression, gender identity, sexual orientation or disability that does not affect that person's ability to perform the work. In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials, or any combination of the foregoing including, but not limited to, public works contracts awarded under public bidding laws or other contracts in which public bids are not required by law, the City, its agencies, boards, or commissions will consider the Contractor's good faith efforts to obtain participation by those subcontractors certified by the State of Indiana as a Minority Business ("MBE") or as a Women's Business Enterprise ("WBE") as a factor in determining the lowest, responsible, responsive bidder. Contractors seeking the award of a City contract cannot be required to award a subcontract to an MWBE; however, they may not unlawfully discriminate against said MBE/WBE. A finding of noncompliance or a discriminatory practice shall prohibit that Contractor from being awarded a City contract for a period of one (1) year from the date of such determination, and such determination may also be grounds for terminating the contact to which the discriminatory practice or noncompliance pertains. 7. The undersigned Contractor agrees that the following nondiscrimination commitment shall be made a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its agencies, boards or commissions. Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the performance of this contract with privileges of employment, or any matter directly or indirectly related to employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation, handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of contract. 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 Version 2/14/2020 Page - 10 Public Works Quote products or foundry products made in the United States on this project if awarded. I understand I have an affirmative duty to notify the City in my bid that my proposal does not include the use of steel products or foundry products made in the United States. I understand it is my sole obligation and responsibility to provide a justification to the City, subject to review and approval, why the cost of United States made steel or foundry products is unreasonable. Prior to award and upon submission of bid which does not use steel products or foundry products made in the United States, the City, through its director of public works, shall make a determination if the price of United States made steel or foundry is unreasonable. I understand that violations hereunder may result in forfeiture of contractual payments. 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 23rd day of March , 20 21 ``%1u I i I r►►I//i ��`ortr a c tors o/i'i 0." COy,P 0 RATEcu NVIG . •'; S rs North. Inc. of Contractor/Bidder or Its Agent Dustin Hilarv, VP of South Bend Area Printed Name and Title Subscribed and sworn to before me this 23rd day of March , 2021 My Commission Expires 6/5/22 Notary Public Alisha Krueger County of Residence St. Joseph Version 2/14/2020 Page - 11 Public Works Quote ALISHA KRUEGER .���4uwru, feR .P�'e�,o; Notary Pubtic, State of Indiana "' }` jEAL; ° St. Joseph County >''• My Commission Expires ';" ��nia�P June 05, 2022 r+um "° Version 2/14/2020 Page - 11 Public Works Quote T Z QUOTE/PROPOSAL N ,:, i CITY OF SOUTH BEND r� PROJECT NAME Charles Martin Parking Lot PROJECT NO. 120-051 R QUOTES DUE Tuesday, March 23rd, 9:00am (local time) Item Total No. Description Quantity UnitUnit Price Amount 1 1 1.5" mill -and -fill as per XVII of Scope of Work 1 LSUM $ $62,952.00 62,952.00 Total Amount of Quote $ 62.952.00 Firm: Address Milestone Contractors North. Inc. 24358 SR 23 City/State/Zip: South Bend, IN 46614 Telephone Number: rS�*4f o�tcactor By,,......'' •• SE •>`����` '������ � . ..Qat Nt/1111t�>> i�011 Fax Number/ (,674 288-4811 ,689-7174 (signature) Dustin Hilary, VP of South Bend Area (Printed Name of Person Signing) Version 2/14/2020 Page - 12 Public Works Quote Part of State Form52414 (R2 / 2-13) Form 96 (Revised 2013) L -oxoy; Milestone Contractors North, Inc. (Contractor) 243358 SR 23 (Address) South Bend IN 46614 FOR PUBLIC WORKS PROJECTS OF City of South Bend, Indiana Charles Martin Parking Lot Project No. 120-051 R Filed March 23. 2021 Action taken State Form 52414 (R 19-10) Prescribed by State Board of Accounts Form No. 96 (Revised 2013) CONTRACTOR'S BID FOR PUBLIC WORK — FORM 96 PART 1 (To be completed for all bids. Please type or print) 1. Governmental Unit (Owner): 2. County: 3. Bidder (Firm): Address: City/State: 4. Telephone Number: 5. Agent of Bidder (If applicable): Date (month, day, year): March 23rd 2021 City of South Bend, Indiana St. Joseph _ Milestone Contractors North, Inc. 24358 SR 23 South Bend, IN 46614 574) 288-481 Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the public works project of City of South Bend. Indiana (Governmental Unit) in accordance with plans and specifications prepared by City of South Bend- Department of Public Works and dated August 28, 2020 for the sum of See Attached $ See Attached. The undersigned further agrees to famish 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 ill be specifically referenced at the applicable page. If additional units of material included in the contract are needed, the cost of units must be the same as that shown in the original contract if accepted by the Governmental Unit. If the bid is to be awarded on a unit basis, the itemization of the units shall be shown on a separate attachment. The Contractor and his subcontractors, if any, shall not discriminate against or intimidate any employee, or applicant for employment, to be employed in the performance of this contract, with respect to any matter directly or indirectly related to employment because of race, religion, color, sex, national origin or ancestry. Breach of this covenant may be regarded as a material breach of the contract. CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS (If applicable) I, the undersigned bidder or agent as a contractor on a public works project, understand my statutory obligation to use steel products made in the United States. I.C. 5-16-8-2. I hereby certify I and all subcontractors employed by me for this project will use U.S. steel products on this project if awarded. I understand that violations hereunder may result in forfeiture of contractual payments. The above bid is accepted this Contracting Authority Members: ACCEPTANCE day of subject to the following conditions: PART II (For projects of $150,000 or more — IC 36-1-12-4) Governmental unit: City of South Bend, Indiana Bidder (Firm): Milestone Contractors North, Inc. Date(month, day, year): March 23, 2021 These statements to be submitted under oath by each bidder with and as part of his bid. Attach additional pages for each section as needed. SECTION I EXPERIENCE QUESTIONNAIRE 1. What public works projects has your organization completed for the period of one (1) year prior to the date of the current bid? Contract Amount Class of Work When Completed Name and Address of Owner $ 12,170,428 Reconstruction Ma 2019 Walsh Construction $ 5,489,454 Resurface November 2019 Lake County Hwy Dqpt $ 4,356,212 Resurface December 2019 C it y of Crown Point $ 3,180,214 Resurface December 2019 St. Joseph County Hwy Dept 3. What public works projects are now in process of construction by your organization? 4. Have you ever failed to complete any work awarded to you? _ _ No If so, where and why? 3 CONTRACT AMT. CLASS OF WORK WHEN TO BE COMPLETED NAME AND ADDRESS OF OWNER $ 6,864,740 Resurface May 2020 INDOT $ 5,902,953 Reconstruction June 2020 INDOT $ 2,473,069 Reconstruction November 2020 INDOT $ 4,090,509 Resurface July 2020 South Bend Regional Airport 4. Have you ever failed to complete any work awarded to you? _ _ No If so, where and why? 3 5. List references from private firms for which you have performed work. Gatlin Plumbing & Heating, Inc. 1111 E. Main St., Griffith IN Ms. Clara Murphy Gough, Inc. 2200 E. 88'h Dr., Merrillville IN 46410 Mr. Ra pond Gough Dyer Construction Co., 1716 Sheffield Avenue, Dyer, IN Janet Furman Grimmer Construction Co., Inc. 2619 Main Street, Highland, IN Mr. Greg Grimmer SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE Explain your plan or layout for performing proposed work. (Examples could include a narrative of when you could begin work, completed the project, number of workers, etc. and any other information which you believe would enable the governmental unit consider your bid.) As required by owner 2. Please list the names and addresses of all subcontractors (i.e. persons or firms outside your own firm who have performed part of the work) that you have used on public works projects during the past five (5) years along with a brief description of the work done by each subcontractor. See Attached List 3. If you intend to sublet any portion of the work, state the name and address of each subcontractor, equipment to be used by the subcontractor, and whether you will require a bond. However, if you are unable to currently provide a listing, please understand a listing must be provided prior to contract approval. Until the completion of the proposed project, you are under a continuing obligation to immediately notify the governmental unit in the event that you subsequently determine that you will use a subcontractor on the proposed project. Will supply upon award of contract QUANTITY ITEM DESCRIPTION, CONDITION SIZE, CAPACITY, ETC. YEARS OF SERVICE PRESENT LOCATION 5 Asphalt Plants Various Good Griffith, South Bend, Valparaiso, Lowell, LaPorte 19 1 Asphalt Pavcrs Various I Gotta I j Griffith, South Bella 4 Sli form Conc. Paver Various Good Griffith, South Bend 3 Road Widener Various Good Griffith, South Bend 5 Motor Graders CAT/J.D. Good Griffith, South Bend 56 Rollers Various Good Griffith, South Bend 36 Rubber Tire Loaders Various Good Griffith, South Bend 18 Excavators Various Good Griffith, South Bend 9 Bulldozers Various Good Griffith, South Bend 7 LowBoy Tractors Various Good Griffith, South Bend 9 Flatbed Dumps Various Good Griffith South Bend 54 %z and 3/ ton Pickups Various Good Griffith, South Bend 78 1 Ton Crew Trucks Various Good Griffith, South Bend 3 Cold Planers Wirtgen 1900 Good DC Griffith, South Bend 72 1 Tri -Axle Dump Mack Good Griffith, South Bend 4. What equipment do you have available to use for the proposed project? Any equipment to be used by subcontractors may also be required to be listed by the governmental unit. Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing your proposal? Otherwise, please explain the rationale used which would corroborate the prices listed. Yes, we received quotes from potential subcontractors and suppliers SECTION III CONTRACTOR'S FINANCIAL STATEMENT Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial statement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to the governing body awarding the contract must be specific enough in detail so that said goveming body can make a proper determination of the bidder's capability for completing the project if awarded. SECTION IV CONTRACTOR'S NON -COLLUSION AFFIDAVIT The undersigned bidder or agent, being duly sworn on oath, says that he has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. He further says that no person or persons, funis, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale SECTION V OATH AND AFFIRMATION I HEREBY AFFIRM UNDER THE PENALTIES FOR PERJURY THAT THE FACTS AND INFORMATION CONTAINED IN THE FOREGOING BID FOR PRBLIC WORKS ARE TRUE AND CORRECT. Dated at South Bend this 23rd day of March, 2021. tf atc tors,����i �`c `•��PORAT��os � STATE OF Indiana ] ss COUNTY OF St. Joseph ] MilestdneZontrictors Nord (Name o rga ViHilarv. VP of South Bend / (Title of Person Signing) GEMENT Before me, a Notary Public, personally appeared the above-named__ Dustin Hilary and swore that the statements contained in the foregoing document are true and correct. Subscribed and sworn to before me this 23rd day of March.. 2021. Alisha Krueger, Notary 4lic My Commission Expires: June 5. 2022 \011 11/11 A L I S H A K R U E G E R moo• Notary Public, state of Indiana —;SEAL."- St. Joseph county County of Residence: St. Joseph My Commission Expires 1 rnnu June05, 2022 Form 96 Section II, #2 Subcontractors Used on Public Works Contracts During the Past 5 Years SUBCONTRACTORS COMPANY ADDRESS CITY/STATE/ZIP PHONE FAX SEWER B & D Sewer Deboer Egolf Delta III Dyer Construction Gatlin Plumbing & Heating Gough, Inc. Grimmer Construction Hasse Construction HRP Construction Rex Construction Wirtz & Yates, Inc. Woodruff & Sons MILLING C.E. Hughes Milling, Inc. Javelina Construction, Inc. Mid America Milling Co. McCrite Milling Specialties Company ELECTRICAL INSTALLATION Hawk Enterprises 531 Winston Ct 5772 Melton Road 2063 W 1250 S 1716 Sheffield Avenue 1111 E. Main Street 2200 E. 88th Drive 2619 Main Street 10 Lincoln Avenue 5777 Cleveland Rd. 700 Schiller Avenue P.O. Box 41 P.O. Box 450 Schererville, IN 46375 Portage, IN 46368 Hanna, IN 46340 Dyer, IN 46311 Griffith, IN 46319 Merrillville, IN 46410 Highland, IN 46322 Calumet City, IL 60409 South Bend, IN 46624 Schererville, IN 46375 Kentland, IN 47951 Michigan City, IN 46361 3113 Holmans Lane Jeffersonville, IN 47130 13476 Britton Park Rd. Fishers, IN 46038 6200 W. Hwy 62, Ste 400 Jeffersonville, IN 47130 209 Quality Ave. Ste 9 New Albany, IN 47150 9350 E. 30th St. Indianapolis, IN 46229 (219) 322-2300 (219) 763-9700 (219) 797-4004 (219) 865-2961 (219) 924-6972 (219) 756-2200 (219) 924-1623 (219 )932-1611 (574)271-7800 (219) 322-8090 (219)474-6542 (219) 872-8605 (812) 725-8665 (317) 841-8364 (812) 282-2751 (812) 941-0252 (317) 594-0291 (219) 865-0065 (219) 763-9703 (219) 797-3008 (219) 865-2963 (219) 924-1401 (219) 756-2202 (219) 924-0328 (219) 932-6829 (574) 271-0524 (219) 322-0031 (219) 8795339 (812) 725-8672 (317) 841-0075 (812) 283-9846 (812)941-0852 (317) 594-0271 1850 E. North St Crown Point, IN 46307 (219) 662-8090 (219) 662-8093 lc')n r- ri,:.,.,,,., n.,,, Cnn+rl,;^_ r, IAI ALi417 M1O\ '107 -AAAA M401 407_f2QQQ S/T Bancroft Electric 25020 State Road 2 South Bend, IN 46619 (574) 287-6490 Sweney Electric Company 9111 Louisiana St. Merrillville, IN 46410 (219) 769-6007 (219) 769-0565 Trans Tech Electric 4601 Cleveland Road South Bend, IN 46619 (574) 272-9673 (574) 271-0144 SIGN INSTALLATION Hawk Enterprises 1850 E. North St Crown Point, IN 46307 (219) 662-8090 (219) 662-8093 Midwestern Electric 1620 E. Chicago Ave East Chicago, IN 46312 (219) 397-4444 (219) 397-8888 RoadSafe Traffic Systems 3122 Olympia Dr Lafayette, IN 47909 (317) 780-1825 State Barricading, Inc. 24963 U.S. Highway 20 South Bend, IN 46628 (574) 287-2078 Traffic Control Specialists, Inc. 1810 W Pacific Avenue Knox, IN 46534 (574) 772-7001 (574) 772-7002 PAVEMENT MARKINGS _ The Airmarking Company P.O. Box 526 Rochester, IN 46975 (574) 223-5817 (574) 223-7959 Blackout Sealcoating 7440 W. 87th Place Bridgview, IL 60455 (219) 864-2300 (708) 430-6910 RoadSafe Traffic Systems 3122 Olympia Dr Lafayette, IN 47909 (317) 780-1825 Barricading, Inc. 24963 U.S. Highway 20 South Bend, IN 46628 (574) 287-2078 ,State Traffic Control Specialists, Inc. 1810 W Pacific Avenue Knox, IN 46534 (574) 772-7001 (574) 772-7002 Traffic Management Company 3542 Highway Avenue Highland, IN 46322 (291) 746-2433 TRAFFIC CONTROL RoadSafe Traffic Systems 3122 Olympia Dr Lafayette, IN 47909 (317) 780-1825 Traffic Control Specialists, Inc. 1810 W Pacific Avenue Knox, IN 46534 (574) 772-7001 (574) 772-7002 Traffic Management Company 3542 Highway Avenue Highland, IN 46322 (219) 746-2433 LANDSCAPE Great American Landscape P.O. Box 235 Dyer, IN 46311 (219) 322-7033 (219) 322-4419 Hubinger Landscape 210 E. 113th Avenue Crown Point, IN 46307 (219) 662-9911 (219) 662-6206 Slusser's Green Thumb, Inc. 125 Montgomery Street Logansport, IN 46947 (574) 722-3102 (574) 722-1628 6 T & J Landscape Service 8253 Wicker Avenue St. John, IN 46373 (219) 374-9900 (219) 374-9950 4410 Ross Road Gary, IN 46408 (219) 972-0193 Superior Construction Co., Inc. 1455 Louis Sullivan Dr Portage, IN 46368 (219) 787-0850 V & R Trucking, Inc. 1845 Elmer St. South Bend, IN 46628 GUARDRAIL/FENCING SRPM'S I Acorn Fence 2041 164th Street Hammond, IN 46320 (219) 844-8400 (219) 844-8441 C Tech Corporation 5300 W. 100 North Boggstown, IN 46110 (317) 835-2745 (317) 835-2781 James H. Drew Company 8701 Zionsville Rd. Indianapolis, IN 46268 (317) 876-3739 (317) 876-3829 Security Industries 1000 Georgiana St. Hobart, IN 46342 (219) 942-9447 (219) 942-9448 Specialties Company 9350 E. 30th St. Indianapolis, IN 46229 (317) 594-0291 (317) 594-0271 TRUCKING/HAULING Lockport, IL 60441 (815) 838-0320 Timber Masters LLC P.O. Box 245 C. Lee Construction Services 1011 S. Lake St Gary, IN 46403 (219) 888-9554 (219) 888-9564 Condon Trucking, LLC 18245 Amberley Ln South Bend, IN 46637 (574) 360-4326 (574) 271-8984 Fanio Services 28015 SR 23 North Liberty, IN 46554 (574) 233-3236 Specialties Company Gilmer Trucking 20390 New Road South Bend, IN 46614 (574) 229-3233 Material Transfer Inc. 7811 West 101st Ave. Crown Point, IN 46307 (219) 865-9575 Morris Motor Service Inc 10525 W US H 30 Bid Wanatah IN 46390 (219) 733-9430 • wy 7 P & C Trucking 4410 Ross Road Gary, IN 46408 (219) 972-0193 Superior Construction Co., Inc. 1455 Louis Sullivan Dr Portage, IN 46368 (219) 787-0850 V & R Trucking, Inc. 1845 Elmer St. South Bend, IN 46628 (574) 329-2102 SRPM'S I K & S Markers, Inc. 2189 N 600 W Thorntown, IN 46071 (765) 482-6184 (765) 482-6284 UNDERSEAL Rieth-Riley Construction Co., 2454 West CR 450 North LaPorte, IN 46350 (219) 362-6178 Inc. TREE REMOVAL Dave's Tree Service 1555 Park West Circle Munster, IN 46321 (219) 922-9829 (219) 922-9843 Homer Tree Service 14000 S. Archer Ave Lockport, IL 60441 (815) 838-0320 Timber Masters LLC P.O. Box 245 Dyer, IN 46311 (219) 864-8733 (219) 322-9391 LIME STABILIZATION Mt. Carmel Sand & Gravel 1611 College Dr. Mt. Carmel, IL 62863 (618) 262-5118 (618) 263-4084 Rock Solid Stabilization 5104 Mann Drive Ringwood, IL 60072 (815) 653-2585 (815) 653-2583 Specialties Company 9350 E. 30th St. Indianapolis, IN 46229 (317) 594-0291 (317) 594-0271 PIPE LINING Indiana Reline, Inc. 312 E. Main Street Sulphur Springs, IN (765) 766-5040 (765) 533-5831 47388 SAW CUTTING Diamond Coring Co., Inc. 11800 S Ewing Ave Chicago, IL 60617 (773) 978-5000 Quality Saw & Seal, Inc. 7600 W. 79th Street Bridgeview, IL 60455 (773) 767-9300 SEAL COATING/STRIPING Site Services, Inc. 10117 Kennedy Ave Highland, IN 46322 (219) 924-9944 Blackout Sealcoating 7440 W. 87th Place Bridgview, IL 60455 (219) 864-2300 (708) 430-6910 UNDERDRAIN 3D Company, Inc. 3200 East CR 350 North Muncie, IN 47303 (765) 288-3326 (765) 288-3344 General Form No. 96-a Prescribed by the State Board of Accounts of Indiana. Revised 1949. Standard t�uestionnaires and Financial Statement for Bidders Prescribed by THE STATE BOARD OF ACCOUNTS OF INDIANA For use in investigating and determining the qualifications of bidders on public construction when the aggregate cost of any such work or improvement will be Five Thousand Dollars or more. These statements to be submitted under oath by each bidder with and as a part of his bid, as provided by Chapter 306, page 1248, Acts of 1947 Submitted to City of South Bend, Indiana By Milestone Contractors North, Inc. IA Corporation Address 1700 E. Main St, Griffith, IN 46319 Date submitted March 23rd, 2021 Filed A.E. BOYCE CO., MUNCIE, IND. 1 Sec. 2 of an Act entitled `AN ACT concerning the awarding of contracts for the performance of public work and authorizing the board of accounts to prescribe certain forms to be used in ascertaining the responsibility of contractors who submit bids for the performance of such work, providing for plans and specifications, providing for bids repealing certain laws and declaring an emergency." (Approved March 13, 1947.) Sec. 2. Whenever the aggregate costs of any work or improvement will be five thousand dollars ($5,000.00) or more, for the purpose of enabling such board, commission, trustee, officer or agent to ascertain and determine which of the bidders submitting bids for the performance of any such public work is, in the judgment of such board, commission, trustee, officer or agent, the lowest and/or best bidder and to exercise intelligently the discretion hereby conferred on such board, commission, trustee, officer or agent each bidder shall be required to submit under oath with and as a part of his bid a statement of his experience, his proposed plan for performing such work and the equipment which he has available for the performance of such work and a financial statement. The statements hereby required shall be submitted on forms which shall be prescribed by the state board of accounts. The forms so prescribed shall be designated, respectively, as the experience questionnaire, the plan and equipment questionnaire and the contractor's financial statement, and shall be based, so far as applicable, on the standard questionnaires and financial statement for bidders as approved and recommended by the joint conference on construction practices, for use in investigating the qualifications of bidders on public construction work, and the forms so prescribed are hereby prescribed as the forms which shall hereafter be used by all such boards, commissions, trustees, officers and agents in obtaining the intormation which is required in the administration of this act. If the information submitted by any bidder on the forms herein prescribed is found, on examination, to be unsatisfactory, the bid submitted by such bidder shall not be considered. (Burns Statutes 1933, Sec. 53-109) Sec. 2, Chapter 306, Acts of 1947. TO THE BIDDER— The following forms of questionnaires and financial statement are prescribed by the State Board of Accounts in conformity with the statute set out on the preceding page. These forms, properly filled out and attested, must accompany each bid of five thousand dollars or more on any public work. The forms are designed to cover all contracts for all kinds of work and the bidder is required to answer such questions as are pertinent to the work upon which he is bidding. The purpose of the questionnaire and financial statement, as set forth in the law, is to enable the awarding body to determine the qualifications of the bidder to carry out successfully the contract if the same is awarded to him. The bidder will find it to his advantage to answer fully all questions coming within the range of the work upon which he is bidding. Particular attention should be given the -Financial Statement" and the details relative to the assets and liabilities set out. This form is made in extensive detail so that the bidder may explain his assets and liabilities in proper sequence and in a uniform manner. T. M. BI DMAN, State Examiner 3 Submitted by Milestone Contractors North, Inc. { x A Corporation Principal Office at 1700 East Main Street, Griffith, IN 46319 To City of South Bend, Indiana _ EXPERIENCE QUESTIONNAIRE The signatory of this questionnaire guarantees the truth and accuracy of all statements and of all answers to interrogatories hereinafter made. 1. How many years has your organization been in business as a general contractor under your present business name? 54 Years 2. How many years experience in asphalt paving construction work has your organization had: (a) As a general contractor 73 years (b) As a sub -contractor 73 Years 3. What projects has your organization completed? Contract Amount Class of Work When Completed Name and Address of Owner $ 12 170 428 Reconstruction May 2019 Walsh Construction $ 5,489,454 Resurface November 2019 Lake County Hwy Dept $ 4,356,212 Resurface December 2019 City of Crown Point $ 3,180,214 Resurface December 2019 St. Joseph County Hwy Dept 3-A. What projects has your organization now in process of construction? CONTRACT AMT. CLASS OF WORK WHEN TO BE COMPLETED NAME AND ADDRESS OF OWNER $ 6,864,740 Resurface May 2020 INDOT $ 5,902 953 Reconstruction June 2020 INDOT $ 1473.069 Reconstruction November 2020 INDOT $ 4,090,509 Resurface July 2020 South Bend Regional Airport 4. Have you ever failed to complete any work awarded to you? No If so, where and why? 5. Has any officer or partner of your organization ever been an officer or partner of some other organization that failed to complete a construction contract? No If so, state name of individual, other organization and reason therefore 6. Has any officer or partner of your organization ever failed to complete a construction contract handled in his own name? No If so, state name of individual, name of owner and reason therefor 7. In what other lines of business are you financially interested? For what corporation or individuals have you performed work, and to whom do you refer? BP Amoco, Whiting, Indiana Torn & Blank Construction 1623 Greenwood Ave., Michigan City, IN 46360 Grimmer Construction Co. Inc. 2619 Main Street Highland, IN 46322 University of Notre Dame, South Bend, Indiana Gough, Inc., E. Summit, Crown Point, IN 46307 9. For what cities have you performed work and to whom do you refer? Town of Griffith Director of Public Works Griffith. IN Town of Schererville Town Man er Schererville IN City of Hammond Cijy Engineer Hammond IN City of South Bend City Engineer South Bend, IN Town of St. John Town Manager St. John IN 10. For what counties have you performed work and to whom do you refer? Lake County Highway YEARS OF CONSTRUCTIO N EXPERIENCE Superintendent Crown Point, IN Porter County Hi hwa Su erintendent Val araiso IN St. Joseph County Highway Exec. Vice President Superintendent South Bend, IN Elkhart County Highway Vice President Superintendent Elkhart, IN Laporte County Highway Vice President Superintendent La orte IN 11. For what State bureaus or departments have you performed work and to whom do you refer? Indiana Department of Transportation (INDOT) LaPorte District Laporte IN Department of Natural Resources Indianapolis, IN _ 12. Have you ever performed any work for the U.S. Government Yes If so, when and to whom do you refer? U.S. Army Cobs of Engineers Chicago, IL Indiana National Guard Dept. of Administration Indianapolis,_IN— Federal Highway Administration Sterling„ VA 13. What is the construction experience of the principal individual of your organization? INDIVIDUAL'S NAME PRESENT POSITION OR OFFICE YEARS OF CONSTRUCTIO N EXPERIENCE MAGNITUDE AND TYPE OF WORK IN WHAT CAPACITY John M. Peisker President 35 All Types General Mana er Mark S. Andrews Exec. Vice President 40 All Types General Manager David J. Misirly Vice President 35 Bituminous Paving En ineer Grejz A. Hoffman Vice President 33 Bituminous Pavin Engineer Jamie L. Tancos Vice President, Secretary/Treasurer 16 Administration General Manager Lynn J. Bauer South Bend Operations Manager 25 All types Engineer Dustin P. Hilary South Bend Area Manager 20 All types Engineer Mark E. Krachenfels Vice President 30 All types Engineer Nikolas G. Relias Project Manager 18 Bituminous Pavin Engineer PLAN AND EQUIPMENT QUESTIONNAIRE The signatory of this questionnaire guarantees the truth and accuracy of all statements and of all answers to interrogatories hereinafter made. 1. In what manner have you inspected this proposed work? Explain in detail. Plans, Specifications, and Site Inspections 2. Explain your plan or layout for performing the proposed work As directed by owner/engineer The work, if awarded to you, will have the personal supervision of whom? Julw M. PeiskCr IvL k S. AliSrewhDacia J. Mhij:1j. Giegury A. Iluffivau Dustui P. Ililar wid 4. *Do you intend to do the hauling on the proposed work with your own forces? Yes If so, give amount and type of equipment to be used As needed *If you intend to sublet the hauling or perform it through an agent, state amount of sub -contract or agent's contract, and if known, the name and address of sub -contractor or agent, amount and type of his equipment and financial responsibility Items 4,5,6 and 7 may not be applicable in all building contracts; if not, omit. 6. *Do you intend to do the grading on the proposed work with your own forces?. If so, give type of equipment to be used 7. *If you intend to sublet the grading or perform it through an agent, state amount of sub -contract or agent's contract, and, if known, the name and address of sub -contractor or agent, amount and type of his equipment and financial responsibility 8. Do you intend to sublet any other portions of the work? If so, state amount of sub -contract, and, if known, the name and address of the sub -contractor, amount, and type of this equipment and financial responsibility 9. From which sub -contractors or agents do you expect to require a bond? None _ 10. What equipment do you own that is available for the proposed work? QUANTITY ITEM DESCRIPTION,., SIZE, CAPACITY, ETC. CONDITION YEARS PRESENT LOCATION OF SERVICE 5 Asphalt Plants Various Good Griffith, South Bend, Valparaiso, Lowell, LaPorte 19 Asphalt Pavers Various Good Griffith, South Bend 4 Sli form Conc. Paver Various Good Griffith, South Bend 3 Road Widener Various Good Griffith, South Bend 5 Motor Graders CAT/J.D. Good Griffith, South Bend 56 Rollers Various Good Griffith, South Bend 36 Rubber Tire Loaders Various Good Griffith, South Bend 18 Excavators Various Good Griffith, South Bend 9 Bulldozers Various Good Griffith, South Bend 7 LowBoy Tractors Various Good Griffith, South Bend 9 Flatbed Dumps Various Good Griffith, South Bend 54 %Z and 3/ ton Pickups Various Good Griffith, South Bend 78 1 Ton Crew Trucks Various Good Griffith, South Bend 3 Cold Planers Wirtgen 1900 DC Good Griffith, South Bend 72 1 Tri -Axle Dump Mack Good Griffith, South Bend 7 11. What equipment do you intend to purchase for use on the proposed work, should the contract be awarded to you? QUANTITYI ITEM j DESCRIPTION, SIZE, CAPACITY, ETC. I APPROXIMATE COST None 12. How and when will you pay for the equipment to be purchased? N/A 13. Do you propose to rent any equipment for this work?No If so, state type, quantity and reasons for renting_ 14. Have you made contracts or received firm offers for all materials within prices used in preparing your proposal? Do not give names of dealers or manufacturers Dated at South Bend this 23rd day of March 2021. (Name By ustin Hilary VP of South Bend Area (Title of Person Signing) Dustin Hilary being duly sworn deposes and says that he is VP of South Bend Area of the above Milestone Contractors North, Inc. (Name of Organization) and that the answers to the questions in the foregoing questionnaires and all statements therein contained are true and correct. Subscribed and sworn to before me this 231 day of March, 2021; — 44dLi�� Alis a eger, Notary Public My Commission expires June 5 2022 "RY rP A L I S H A K R U E G E R Notary Public, state of Indiana 8 *;.SEAL:5t. Joseph County %>, iN••.•''y *�" My Commission Expires nnu"` June 05, 2022 I I1 Nl',,� `,`10U �01 0300rs '1'1 0. 'BO�� RATE : S IIIt%\\ STATE OF Indiana { ss. COUNTY OF. St. Joseph (Name By ustin Hilary VP of South Bend Area (Title of Person Signing) Dustin Hilary being duly sworn deposes and says that he is VP of South Bend Area of the above Milestone Contractors North, Inc. (Name of Organization) and that the answers to the questions in the foregoing questionnaires and all statements therein contained are true and correct. Subscribed and sworn to before me this 231 day of March, 2021; — 44dLi�� Alis a eger, Notary Public My Commission expires June 5 2022 "RY rP A L I S H A K R U E G E R Notary Public, state of Indiana 8 *;.SEAL:5t. Joseph County %>, iN••.•''y *�" My Commission Expires nnu"` June 05, 2022 The name of the partnership firm under which the above partners are operating is Give names and titles of all persons having authority to execute and receipt estimate vouchers and to conduct other business for the partnership, the signatures of whom are legally binding. The undersigned hereby declares that the foregoing is a true statement of the financial condition of the individual, co -partnership or corporation herein first named, as of the date herein first given; that this statement is for the e. es • purpose of inducing the party to whom it is submitted to award the submittor a contract; and that any depository, vendor or of rag cy heytin named is hereby authorized to supply such party with any information necessary to verify this statement. 7 NOTE: A co -partnership must give firm name and signatures of all partners. A corporation must give full corporate name, signature of official and affix corporate seal. 111url/i�♦ error ♦♦// (Applicant must sign here) Subscribed and sworn to before me this day of 20 Notary Public Affidavit for Co -Partnership STATE OF I COUNTY OF l SS being duly sworn, deposes and says that he is a member of the firm of . that he is familiar with the books of the said firm showing its financial condition; that the foregoing financial statement, taken from the books of the said firm , is a true and accurate statement of the financial condition of the said firm as of the date thereof and that the answers to the foregoing interrogatories are true. (Member of firm must sign here) Subscribed and sworn to before me this day of 20 Notary Public Affidavit for Corporation STATE OF Indiana { COUNTY OF St. Jss oK h Dustin Hilary being duly sworn, deposes and says that he is VP of South Bend Ar the ilestone Contractors North. Inc. the corporation described in and which executed the foregoing statement; that he is ' ar wi i e books of the said corporation showing its financial condition; that the foregoing financial statement, taken from a oks o ' e said • oration, is a true and accurate statement of the financial condition of said corporation as of the date thereof a th the an ie foregoing interrogatories are true. ( i fnusf sign here) Dustin Hilary, VP of SOWOR" 47a Subscribed and sworn to before me this �tcattQr ♦i/ Lo•,.......... 'T 23rd da of March 2021.�*oC . `SRP O R re. .'o~s Alis rueger, Notary Public may'., SEAL ; • �' ALISHA KRUEGER // b'NtilaNA ' :.•`' SFR"' Notary Public. State of Indiana 15 ♦♦/1111{111 �� 'z;SEAL* St. Joseph County ¢_ My Commission Expires S.�ivoj;;NP�` June 05, 2022 -- - �_� `U qTF tom' Affidavit for Individual �L'•, SEAL n STATE OF ��� • :' •bNviaN� Aeo ss: COUNTY OF ♦ � being duly sworn, deposes and saysl Itit�tlthe foregoing financial statement, taken from his books, is a true and accurate statement of his financial condition as of the date thereof and that the answers to the foregoing interrogatories are true. (Applicant must sign here) Subscribed and sworn to before me this day of 20 Notary Public Affidavit for Co -Partnership STATE OF I COUNTY OF l SS being duly sworn, deposes and says that he is a member of the firm of . that he is familiar with the books of the said firm showing its financial condition; that the foregoing financial statement, taken from the books of the said firm , is a true and accurate statement of the financial condition of the said firm as of the date thereof and that the answers to the foregoing interrogatories are true. (Member of firm must sign here) Subscribed and sworn to before me this day of 20 Notary Public Affidavit for Corporation STATE OF Indiana { COUNTY OF St. Jss oK h Dustin Hilary being duly sworn, deposes and says that he is VP of South Bend Ar the ilestone Contractors North. Inc. the corporation described in and which executed the foregoing statement; that he is ' ar wi i e books of the said corporation showing its financial condition; that the foregoing financial statement, taken from a oks o ' e said • oration, is a true and accurate statement of the financial condition of said corporation as of the date thereof a th the an ie foregoing interrogatories are true. ( i fnusf sign here) Dustin Hilary, VP of SOWOR" 47a Subscribed and sworn to before me this �tcattQr ♦i/ Lo•,.......... 'T 23rd da of March 2021.�*oC . `SRP O R re. .'o~s Alis rueger, Notary Public may'., SEAL ; • �' ALISHA KRUEGER // b'NtilaNA ' :.•`' SFR"' Notary Public. State of Indiana 15 ♦♦/1111{111 �� 'z;SEAL* St. Joseph County ¢_ My Commission Expires S.�ivoj;;NP�` June 05, 2022 -- State of Indiana Office of the Secretary of State CERTIFICATE OF EXISTENCE To Whom These Presents Come, Greeting: I, CONNIE LAWSON, Secretary of State of Indiana, do hereby certify that I am, by virtue of the laws of the State of Indiana, the custodian of the corporate records and the proper official to execute this certificate. I further certify that records of this office disclose that MILESTONE CONTRACTORS NORTH, INC. duly filed the requisite documents to commence business activities under the laws of the State of Indiana on March 29, 1966, and was in existence or authorized to transact business in the State of Indiana on March 16, 2021. 1 further certify this Domestic For -Profit Corporation has filed its most recent report required by Indiana law with the Secretary of State, or is not yet required to file such report, and that no notice of withdrawal, dissolution, or expiration has been filed or taken place. All fees, taxes, interest, and penalties owed to Indiana by the domestic or foreign entity and collected by the Secretary of State have been paid. sTar� �1 ••,.► In Witness Whereof, I have caused to be affixed my signature and the seal of the State of Indiana, at the City 0rY of Indianapolis, March 16, 2021 ;A wt ' ••ra�$'�. * CONNIE LAWSON SECRETARY OF STATE 194484-057 / 20211917617 A]I certificates should be validated here: https://bsd.sos.in.gov/validateCertificate Expires on April 15, 2021. State of Indiana Office of the Secretary of State Certificate of Amendment of WALSH & KELLY INC I, CONNIE LAWSON, Secretary of State, hereby certify that Articles of Amendment of the above Domestic For -Profit Corporation have been presented to me at my office, accompanied by the fees prescribed by law and that the documentation presented conforms to law as prescribed by the provisions of the Indiana Code. The name following said transaction will be: MILESTONE CONTRACTORS NORTH, INC. NOW, -THEREFORE, with this document I certify that said transaction will become effective Monday, February 01, 2021. "TA In Witness Whereof, I have caused to be affixed my signature and the seal of the State of Indiana, at the City of Indianapolis, February 01, 2021 CM44�� C%3 ""M CONNIE LAWSON SECRETARY OF STATE 1944.84-057 / 8878219 To ensure the certificate's validity, go to https://bsd.sos.in-gov/PublicBusiness5earch State of Indiana Office of the Secretary of State Certificate of Assumed Business Name of MILESTONE CONTRACTORS NORTH, INC. I, CONNIE LAWSON, Secretary of State, hereby certify that a Certificate of Assumed Business Name of the above Domestic For -Profit Corporation has been presented to me at my office, accompanied by the fees prescribed by law and that the documentation presented conforms to law as prescribed by the provisions of the Indiana Code. Following said transaction, the above named entity will transact business under the assnmPrl business name(s) of: WALSH & KELLY NOW, THEREFORE, with.this document I certify that said transaction will become effective Monday, February 01, 2021. In Witness Whereof, I have caused to be affixed my signature and the seal of the State of Indiana, at the City of Indianapolis, February 01, 2021. CONNIE LAWSON SECRETARY OF STATE 194484-0357 / 8878234 To ensure the certificate's validity, go to https://bsd.sos.in.gov/PubflcBusinessSearch Form WA Request for Taxpayer Give Form to the (Rev. October 2018) Identification Number and Certiflcation requester. Do not Department of the Treasury send to the IRS. Intemal Revenue Service D Go to www.irs.gov/F`ormW9 for instructions and the latest information. 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. MILESTONE CONTRACTORS NORTH, INC. 2 Business name/disregarded entity name, If different from above WALSH & KELLY, INC. 7 1 ist Penni mt m,mhe,(s) horn turf—PI) T L Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number backup withholding. For individuals, this is generally your social security number (SSN. However, for a - M resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later, or Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Employer identification number Number To Give the Requesterfor guidelines on whose number to enter. 3 5 -� 1� 1 2 D 3F6M85 Balis. Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or 1 am waiting for a number to be issued to me); and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification Instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than Interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later. Sign Signature of % Here U.S. person 10- 14. 0-1o l& W &-0 1 t Date Ill - General General Instructions • Form 1099 -DIV (dividends, including those from stocks or mutual Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.frs.gov1FormW9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an Information return. Examples of information returns include, but are not limited to, the following. • Form 1099 -INT (interest earned or paid) funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do -not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231X Form W-9 (Rev. 10-2018) 9 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to following seven boxes. certain entities, not individuals; see CL c o ❑ Individual/sole ro netor or ❑ C Corporation Q S Corporation p p rp ❑ Partnership ❑ Trust/estate instructions on page 3): in ai singie-member LLC Exempt payee code (if any) c ❑ Umited liability company. Enter the tax classification (C=C corporation, S=S corporation, P --Partnership) ► 0 2 m Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check LLC if the LLC is classified ' Exemption from FATCA reporting e as a single -member LLC that is disregarded from the owner unless the owner of the LLC is code if arty) ( z a another LLC that Is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that v is disregarded from the owner should check the appropriate box for the tax classification of its owner. m ❑ Other (see Instructions) 0- merahadcu&& ne u (pugs to=cwxs ms.) H 5 Address (number, street, and apt. or suite no.) See instructions. T Requester's name and address (optional 1700 EAST MAIN STREET rm 6 City, state, and ZIP code GRIFFITH, IN 46319 7 1 ist Penni mt m,mhe,(s) horn turf—PI) T L Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number backup withholding. For individuals, this is generally your social security number (SSN. However, for a - M resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later, or Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Employer identification number Number To Give the Requesterfor guidelines on whose number to enter. 3 5 -� 1� 1 2 D 3F6M85 Balis. Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or 1 am waiting for a number to be issued to me); and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification Instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than Interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later. Sign Signature of % Here U.S. person 10- 14. 0-1o l& W &-0 1 t Date Ill - General General Instructions • Form 1099 -DIV (dividends, including those from stocks or mutual Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.frs.gov1FormW9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an Information return. Examples of information returns include, but are not limited to, the following. • Form 1099 -INT (interest earned or paid) funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do -not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231X Form W-9 (Rev. 10-2018) CERTIFICATE OF QUALIFICATION to provide CONSTRUCTION SERVICES for PUBLIC WORKS PROJECTS to the STATE OF INDIANA This Certification Board, having duly considered application for qualification in terms of apparent experience and financial resources; and under the applicable Indiana Code 4-13.6-4 and adopted rules of this Board, hereby issues a Certificate of Qualification to provide construction services to the State of Indiana for Public Works Projects to: WALSH - KELLY INC 1700 E MAIN ST GRIFFITH IN 46319 Phone 219-924-5900 Fax 219-924-8768 Company Official JOHN PEISKER for the twenty-seven month period stated herein, unless revoked by this Board for cause, and in the classifications of services stated below. This certificate supercedes any previous certificate. 1611.01 Concrete Construction of Roads & Curbing 1611.02 Asphalt Construction of Roads and Parking Lots CERTIFICATION DATE 11/4/2020 EXPIRATION DATE 2/4/2023 THIS CERTIFICATE ISSUED BY THE STATE OF INDIANA, PUBLIC WORKS DIVISION CERTIFICATION BOARD, 402 WEST WASHINGTON STREET, ROOM W467, INDIANAPOLIS, INDIANA 46204, ALSO ACTS AS THE OFFICIAL NOTICE OF EXPIRATION. �� _ �]r • CK" -A --J Tracy L. Cross, Ex tive Secretary Certification Board DAPW P02 State Form 3983R Rev. 07/06 WRITTEN CONSENT TO RESOLUTIONS of the BOARD OF DIRECTORS of WALSH & KELLY, INC. The undersigned, being all of the Directors of WALSH & KELLY, INC., an Indiana Corporation, hereby consent to the following actions to be taken by the Corporation without a meeting of the Board of Directors under the applicable provisions of the Indiana Business Corporation Law, as amended: RESOLVED that the following be, and hereby are, elected officers of the Corporation, to hold the office until the next regular meeting of the Board of Directors and until their successors are duly elected and have qualified: . John M. Peisker, President Jeffrey L. Swan, Executive Vice President John P. Vercruysse, Executive Vice President Jamie L. Tancos, Vice President of Finance, Secretary & Treasurer Gregory A. Kelly, Vice President Charles Potts Jr., Vice President Albert E.VanDenBergh, Vice President David L. Franz, Vice President David J. Misirly, Vice President Gregory A. Hoffman, Vice President Dustin P. Hilary, Vice President Lynn J. Bauer, Vice President Mark E. Krachenfels, Vice President RESOLVED FURTHER that the actions of the Officers of the Corporation taken since the last meeting of the Board of Directors be, and the same hereby are, fully ratified and approved. RESOLVED FURTHER that the following be, and they hereby are, authorized to execute all contracts or similar documents on behalf of the Corporation: John M. Peisker, President Jeffrey L. Swan, Executive Vice President John P. Vercruysse, Executive Vice President Jamie L. Tancos, Vice President of Finance, Secretary & Treasurer Gregory A. Kelly, Vice President Charles Potts Jr., Vice President Albert E.VanDenBergh, Vice President David L. Franz, Vice President David J. Misirly, Vice President Gregory A. Hoffman, Vice President Dustin P. Hilary, Vice President Lynn J. Bauer, Vice President Mark E. Krachenfels, Vice President RESOLVED FURTHER that this consent shall be in lieu of an annual meeting ofthe Board of Directors of the Corporation and shall be filed in the minute book of the Corporation in place of any such annual minutes. <<SIGNATURES ON THE NEXT PAGE>> EXECUTED this 15`x' day of January, 2020. Fred Feb, e feld, Jr. Albert E. VanDenBergh Kevin J. Kelly James . Fehsenfeld .0 J n P. Vercruysse J EXECUTED this 15" day of January, 2020. Fred Fehsenfeld, Jr. James C. Fehsenfeld Albert E. VanDenBergh John P. Vercruysse Kevin J. Kelly EXECUTED this 15'h day of January, 2020. Fred Fehsenfeld, Jr. Albert E. VanDenBergh Kevin I Kelly' " i James C. Fehsenfeld John P. Vercruysse Pli Milestone EQUAL EMPLOYMENT OPPORTUNITY/ AFFIRMATIVE ACTION POLICY STATEMENT It is the policy of Milestone Contractors to afford equal opportunity for employment to all individuals regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, housing status, or veterans' status. The corporation is committed to this policy by our status as a federally assisted government contractor. We are far more strongly bound to the policy by the fact that adherence to the principles involved is the only acceptable American way of life. Therefore, it is the policy of this corporation to assure that applicants are employed, and that employees are treated during employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, housing status, or veterans' status. Such action shall include: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship, pre - apprenticeship, and/or on-the-job training. The successful achievement of a nondiscriminatory employment program requires a maximum of cooperation between management and employees. In fulfilling its' part in this cooperative effort, management is obliged to lead the way by establishing and implementing affirmative procedures and practices which will ensure our objective, namely equitable employment opportunity for all. (Minority and female employees are encouraged to participate in all company activities and refer applicants.) I have designated Margaret Garner to direct the establishment of and to monitor the implementation of personnel procedures to guide our affirmative action program. This official is charged with designing and implementing audit and reporting systems that will keep management informed on a regular basis of the status of equal employment opportunity and affirmative action. She can be reached at (317)616-4937. Supervision has been made to understand that their work performance is being evaluated based on their equal employment opportunity efforts and results, as well as other criteria. It shall be a responsibility of the supervision to take actions to prevent harassment of employees placed through affirmative action efforts. We shall comply with the Civic Rights Act of 1964, as amended, the Federal Highway Act of 1968, the Executive Order #11246 and #11375, the Rehabilitation Act of 1973, as amended, the Vietnam Era Veterans Readjustment Assistance Act of 1974, as amended, the Indiana Civil Rights Act and other applicable Federal and State Laws and regulations pertaining to equality of Opportunities and Affirmative Action policies. We have developed an Affirmative Action Program for Veterans and Individuals with Disabilities. CJ Pofts, Chief Operating Officer Margaret Garner, HR Area Partner/EEO Officer February 2021 EOE 1VI/F/Vets/Disabled F,i,l milestone DATE: February 26, 2021 TO: All Employees RE: EEO Officer Appointment Margaret Garner has been appointed Equal Employment Opportunity Officer for Milestone Contractors. It is her responsibility to coordinate, advise and assist management and supervisors in their responsibilities of assuring all applicants and employees' equal opportunities in all aspects of their employment. She will review complaints that allege discrimination because of race, religion, color, sex, sexual orientation, gender identity, age, national origin, disability, housing status or veteran status. Employees of Milestone Contractors are to submit any issues or concerns to Margaret. We are committed to comply with the provisions of the Civil Rights Act of 1964 and 1991, plus all Executive Orders issued relating to Equal Employment. Margaret's contact information is listed below. Milestone Contractors 7661 N Perimeter Rd, Suite 200 Indianapolis, IN 46241 mgarner@ milestonelp.com (317)616-4937 CJ Pacts, Chief Operating Officer (5miffi-ate Jarf qutdiruntfim ISSUED BY V� _+ ?Ubima 39-rf Jf Qrr= =rUrt `-4 INDIANAPOLIS, IN May 21, 2020 _ TO WALSH & KELLY INC GRIFFITH, IN who has filed with the Department a Contractor's Statement of Experience and Financial Condition as required under Indiana Code 8-23-10, is hereby qualified to bid at any Department of Transportation letting in Classes of Work and within the amount and other limitation of each classification as listed below, for such period as the uncompleted work on hand from all sources does not exceed the Aggregate amount. Classification references by name or symbol are in accordance with the definitions in the Contractor's Statement of Experience and Financial Condition. This certificate supersedes any certificate previously issued, but is subject to revision or revocation according to the law, if and when changes in the financial condition of the contracting firm or other facts justify such revision or revocation. Valid May 21, 2020 Thru April 30, 2021 AGGREGATE....................................................................................................................... ................ $UNLIMITED A(B) CONCRETE PAVEMENT: LIMITED......................................................................................................... $25,000,000 B(A) ASPHALT PVMT: W/INDOT CERTIFIED HMA PLANT...........................................................................$UNLIMITED C(B) LIGHT GRADING........................................................................................................................................$UNLIMITED E(E) SMALL STRUCTURES AND DRAINAGE ITEMS.................................................................................... $25,000,000 E(F) SURFACE MASONRY AND MISC CONCRETE....................................................................................... $50,000,000 E(G) TRAFFIC CONTROL: PAVEMENT MARKINGS...................................................................................... $25,000,000 E(H) DEEP SEWER AND/OR EXCAVATION.................................................................................................... $25,000,000 E(Q) CONCRETE PAVEMENT: REPAIRS......................................................................................................... $25,000,000 E(R) ASPHALT PAVEMENT MILLING.............................................................................................................. $50,000,000 PREQUALIFICATION ENGINEER State Form 20508 (113 / 5-05) COMMISSIONER NOTES: PREQUALIFICATION WORKSHEET PRINTED: 5/21/2020 PQA APPROVED: 5/7/2020 ACCT: #35-1120685 ALT ACCT: # 0449 NEW? SUPP? APPROVED BY: NAME: WALSH & KELLY INC DATE: 5/21/2020 December 31, 2019 CURRENT FIXED EQUIPMENT ASSETS REPORTED $47,119,378.00 $10,219,627.00 $31,032,017.00 VALID: 5/21/2020 LIABILITIES REPORTED ($16,158,151.00) ($16,742,213.00) EXPIRES: 4/30/2021 DENIAL DATE: NET ASSETS REPORTED $30,961,227.00 ($6,522,586.00) $31,032,017.00 DENIAL REASON: 09 OMIT NO DETAIL OR QUANTITY ($4,016,185.00) $0.00 $0.00 11 OMIT NO DETAIL ($277,917.00) $0.00 $0.00 15 CASH SURRENDER VALUE $1,390,248.00 ($1,390,248.00) $0.00 16 OMIT INTANGIBLES $0.00 ($864,210.00) $0.00 22 DUE AFTER 24 MONTHS $0.00 $13,536,060.00 $0.00 NET FIXED ASSETS $0 NET FIXED ASSETS EQUIPMENT $0 COMPONENT - ------------------------------------ ---------------------------------------------------------- RATING -------------------- CURRENT $280,573,730.00 NET ACCEPTABLE ASSETS $28,057,373 54.759.016 $31,032,017 FIXED $9,518,032.00 RATING FACTORS X 10 X 2 X:8 -------------------- ------------------------------------------------------------ -- --- EQUIPMENT $248_,256__,136.00 RATING COMPONENTS $280,573,730 $9,518,032 $248,256,136 MAXIMUM BALANCE $538,347,898.00 X 1.5 - $248,256,136 MAXIMUM EQUIPMENT $420,860,595 $0 STATEMENT TYPE: AUDITED 8.00 EXPER. REDUCTION 0% $248,256,136 $0 AGGREGATE UNLIMITED + $280,573,730 + $4,759,016 C(B) UNLIMITED $528,829,866 $4,759,016 B(A) UNLIMITED X 0.25 X 2 E(F) $50,000,000 MAXIMUM FIXED $132,207,467 ADJ. FIXED $9,518,032 -------------------------- E(E) $25,000,000 BALANCE SHEET ANALYSIS ---------------------------------------- E(R) $50,000,000 CURRENT ASSETS: $47,119,378 CURRENT RATIO: 2.916 A(B) $25,000,000 -------------------------------------------------------------- INVENTORY: $4,016,185 QUICK RATIO: 2.668 E(Q) $25,000,000 -------------------------------------------------------------- CURRENT LIABILITIES: ----------------------------------------------- $16,158,151 WORKING CAPITAL: $30,961,227 E(H) $25,000,000 --------------------------------------- ------------------- LONG TERM LIABILITIES: ---------------------------------------------- $16,742,213 DEBT/NET WORTH: ---------------- 0.593 E(G) $25,000,000 N ET WORTH: -------------------------------------------------------------- $55,470,656 TOTAL LIABILITIES: $32,900,364 NOTES: