HomeMy WebLinkAboutOpening & Award of Bid - 2020 Community Crossings Round 2 Proj No. 120-059 - Milestone Contractors North, Inc.=ice ay .
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CITY OF SOUTH BEND, INDIANA''x� Y
CONTRACTOR'S BID FOR PUBLIC WORK
CHECKLIST FOR BIDDERS
Project Name 2020 Community Crossings Round 2
Project No. 120-059
For Bids Due April 13, 2021, 9:00 a.m., Local Time
From time to time the South Bend Board of Public Works finds it necessary to reject a bid because
it does not comply with statutory requirements. In preparing your bid, please use the following
checklist in order to make sure that your bid is done in the proper manner.
Proper bid security included. The bidder has the option of providing either a Certified Check
X or Bid Bond.
Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely
X executed.
Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments
with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and
X Certification of use of United States Steel Products or Foundry Products.
Proof of 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
X [MWBE-2.1].
X Acknowledge Receipt of 1 & 2 Addendum(s) included with the bid.
X All required additional information is included with the bid.
Proposal statements and other affidavits all signed by the proper party with name either
X printed or typed underneath signature.
X This checklist submitted with the Bid.
This checklist is provided for bidder's use in assuring compliance with required
documentation; however, it does not include all specifications requirements and does not
relieve the bidder of the need to read and comply with the specifications.
Bidder:
By Authorized Represe2in
Signature:
Print Name & Title:
Area
Version 01/13/2021 Contractor's Bid for Public Works - 1
Date: 4/13/2021
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CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
Project Name 2020 Community Crossings Round 2
Project No. 120-059
For Bids Due April 13, 2021, 9:00 a.m., Local Time
PART I
(Must be completed for all bids. Please type or print)
Date: 4/13/2021 Bidder (Firm): Milestone Contractors North. Inc.
Address: 24358 SR 23
City/State/Zip: South Bend, IN 46614 Telephone Number: i 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:
City of South Bend - 2020 Community Crossings Round 2
the City of South Bend, Indiana, in accordance with plans and specifications prepared by:
Der)artment of Public Works - City of South Bend
and dated March 11, 2021 for the sum of (enter the Total Bid as shown on the Proposal)
Two hundred eighty seven thousand two hundred dollars and zero cents i$
(Enter sum of Total Base Bid plus Alternates shown on Proposal)
287,200.00
(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 refergAced at the applicable page.
If additional units of material included in the contract are neede he c st of units must be the same as that
shown in the original contract if accepted by the City of So Be . If the bid is to be awarded on a unit
basis, the itemization of the units shall be shown on a se rate tachment.
By f
f �—
(Signature)
(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
Joseph R. Molnar, Member
Jordan V. Gathers, Member
Attest: Anne Fuchs, Clerk
Version 01/13/2021 Contractor's Bid for Public Works - 2
20
PART II
(For projects of $100,000 or more — IC 36-1-124)
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
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.
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, 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 products or foundry
products made in the United States on this project if awarded. I understand I have an affirmative duty to
notify the City in my bid that my proposal does not include the use of steel products or foundry products
made in the United States. I understand it is my sole obligation and responsibility to provide a justification
to the City, subject to review and approval, why the cost of United States made steel or foundry products is
unreasonable. Prior to award and upon submission of bid which does not use steel products or foundry
products made in the United States, the City, through its director of public works, shall make a determination
if the price of United States made steel or foundry is unreasonable. I understand that violations hereunder
may result in forfeiture of contractual payments.
Version 01/13/2021 Contractor's Bid for Public Works - 5
I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid
for public works are true and correct.
Dated this 13th day of April , 20 21
Miles(tona(Contraetors North Inc.
Cor�tPactor idder {F )
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ture of ContractorBidder or Its Agent
Dustin Hila VP of South Bend Area
'� '•' �.`�
Printed Name and Title
Subscribed and sworn to before me this 13th day of_ April . 20 21
My Commission Expires 6/5/22 _
Notary Public AI• ha Krueger
County of Residence St. Joseph
ALISHA KRUEGER
w�PPY'PUe-", Notary Public, State of Indiana
St. Joseph County i
_
My Commission Expires N
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JuneO5,2022
r, m,
Version 01/13/2021 Contractor's Bid for Public Works - 6
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: April 9, 2021
To: All Planholders
From Anne Fuchs, Clerk, Board of Public Works
Subject Addendum Number: 2
Project Name: 2020 Community Crossings Round 2 _
Project No.: 120-059
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM
Date Received: 4/9/2021
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.
Authorized Signature:
1316 COUNTY -CITY BUILDING
227 W.JEFFERSON BOULEVARD
SOUTH BEND, INDIANA 46601-1830
Date:
To:
From
Subject
PHONE 574/235-9251
FAx 574/ 235-9171
TDD 574/ 235-5567
CITY OF SOUTH BEND JAMES MUELLER, MAYOR
BOARD OF PUBLIC WORKS
April 2, 2021
All Planholders
Anne Fuchs, Clerk, Board of Public Works
Addendum Number: 1
Project Name: 2020 Community Crossings Round 2
Project No.: 120-059
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM
Date Received: 4/2/2021
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:
77n hoary,Date: 4/13/7C1g1
Inc.
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BID/PROPOSAL
CITY OF SOUTH BEND
PROJECT NAME: 2020 Community Crossings Round 2
PROJECT NO. 120-059
FOR BIDS DUE: April 13, 2021 @ 9:00 a.m. Local Time i6as :-
CONTRACTOR NAME: Milestone Contractors North, Inc.
DIVISION A: BOWMAN STREET FROM MIAMI STREET TO LEER STREET
Item
No.
Line Item
Quantity
Unit
Unit Price
Cost
1
Maintenance of Traffic
1
1
LS
LS
10,258.00
4,650.00
$10,258.00
$4,650.00
$10,810.00
2
Mobilization and Demobilization
3
Milling, Up to 3"
4700
SY
2.30
4
HMA Surface, 9.5 mm — Type B
780
TONS
69.30
$54,054.00
5
HMA Wedge and Leveling —Type B
HMA for Patching
39
TONS
69.00
$2,691.00
6
9
TONS
150.00
$1,350.00
7
Tack Coat
2
TONS
10.00
$20.00
8
Joint Adhesive, Surface
1300
6
LF
EA
4.00
200.00
$5,200.00
$1,200.00
$2,750.00
9
Adjust Manhole to Grade
10
Adjust Inlet to Grade
10
EA
275.00
Transverse Marking, Thermoplastic, Solid, White,
11 6" 60 LF 6.95
DIVISION A TOTAL
$417.00
$93,400.00
Version 01/13/2021 Contractor's Bid for Public Works - 7
BID/PROPOSAL
CITY OF SOUTH BEND
PROJECT NAME:
2020 Community Crossings Round 2
PROJECT NO.
120-059
FOR BIDS DUE:
April 13, 2021 @ 9:00 a.m. Local Time
CONTRACTOR NAME:
Milestone Contractors North, Inc.
DIVISION B: RIDGEDALE ROAD FROM YORK ROAD TO WOODMONT DRIVE
Item
No. Line Item
I
Quantity
Unit
Unit Price
Cost
1
Maintenance of Traffic
1
LS
14,984.00
$14,984.00
2
Mobilization and Demobilization
1
LS
9,680.00
$9,680.00
3
4
Milling, 3"
HMA Surface, 9.5 mm — Type B
11060
SY
2.20
$24,332.00
1820
TONS
66.40
$120,848.00
5 HMA Wedge and Leveling —Type B
91
TONS
66.00 $6,006.00
6 HMA for Patching
7 Tack Coat
22
TONS
150.00
10.00
$3,300.00
$80.00
$9,920.00
8
TONS
8
Joint Adhesive, Surface
2480
LF
4.00
9 lAdjust Manhole to Grade
9
EA
200.00
$1,800.00
10
Adjust Water Valve Structure to Grade
1
EA
100.00
$100.00
$2,750.00
11 Adjust Inlet to Grade 10 EA 275.00
DIVISION B TOTAL
$193,800.00
Version 01/13/2021 Contractor's Bid for Public Works - 8
PROJECT NAME:
PROJECT NO.
FOR BIDS DUE:
CONTRACTOR NAME:
BID/PROPOSAL
CITY OF SOUTH BEND
2020 Community Crossings Round 2
120-059
April 13, 2021 @ 9:00 a.m. Local Time
Milestone Contractors North, Inc.
DIVISIONS 1 AND 2 TOTAL:
The Contractor must bid on all Divisions to be eligible for award.
$287,200.00
Bidder(Firm):
Milestone Contractors North, Inc.
Address:
24358 SR 23
City/State/Zip
South Bend,IN 46614
Telephone Number:
574-288-4811
Fax Number:
574-289-7174
0%%j j I I I lII,11,
A
ontractors
ORAtf 's L
(Signature)
• „ �
=
Dustin Hilary, V.P. of South Bend Area
��
(Printed Name of Person Signing)
Version 01113/2021 Contractor's Bid for Public Works 9
�d y
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MWBE-1.0
MWBE UTILIZATION PLAN
-'
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MBE participation. It is
the bidder's sole responsibility to verify whether any listed minority or woman business meets the MBE qualifications.
Project Number: 120-059 Project Name: 2020 Community Crossings Round 2
Bidder: Milestone Contractors North, Inc. Total Bid Amount: $287,200.00
Name & Address of MBE Primary Contact Person Scope of Work to be Performed
(Name/Telephone) I (Attach scope/schedule if you need additional space)
C. Lee Construction Services, Inc. Frederick "Chip" Lee Hauling
1011 S. Lake Street 219-888-9554
Gary, IN 46403
Submitted by: Dustin Hilary
Print Name lg i
Version 01/13/2021 Contractor's Bid for Public Works - 10
MBE Goal: 3.9%
Page 1 of 1
Dollar Amount of MBE Percentage
Component of Total
Bid/Proposal
$11,201.00 I 3.9%
Date I (
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MWBE-1.0 _ -
MWBE UTILIZATION PLAN pass"
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: 120-059 Project Name: 2020 Community Crossings Round 2_
Bidder: Milestone Contractors North Inc. Total Bid Amount: $287,200.00 WBE Goal: 5.9%
Page of
Primary Contact Person Scope of Work to be Performed Dollar Amount of WBE Percentage
Name & Address of WBE Name/Tele hone of Total
( p ) (Attach scope/schedule if you need additional space) I Component OWID— —1
V & R Trucking, Inc. Veda Godette Hauling - Materials 8 1845 N. Elmer Street 574-234-1268 $13,800.00 4.°/o
South Bend, IN 46628
State Barricading, Inc. James Michalski Traffic Control Devices $3,378.00 1.1%
24963 US 20 574-287-2078
South Bend, IN 46628
Submitted by: Dustin_Hila�
Print Name ature Date
Version 01/13/2021 Contractor's Bid for Public Works -11
CITY OF SOUTH BEND4,,
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MWBE-2.0
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:
120-059
Project Name: 2020 Community Crossings Round 2
Bidder: Milestone Contractors North, Inc.
Contact Person
Date: 4/13/2021
Edward Pilipow Telephone: 574-288-4811
Address: 24358 SR 23
City: South Bend State: Indiana
Zip: 46614
Email: epili�milestonelp.com
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,
REQUIRE ALL of the following Good Faith Efforts as listed in the table below":
EVIDENCE OF GOOD FAITH EFFORTS
MWBE LIST(5): 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: httpJlwww.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
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
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b
CITY OF SOUTH BEND t r�
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN rEICE' tl
FORM MWBE-2.0 =<"
.r
EVIDENCE OF GOOD FAITH EFFORTS
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 all of the above boxes. Any
omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of
South Bend reserves the right to request additional information.
Version 01/13/2021 Contractor's Bid for Public Works - 13
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MWBE-2.1�
MWBE CONTACTED
i'
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 1 OF 2
Project Number: 121-016 MBE Participation Goal 4.2%
Project Name:Y21tractorPavin Round 1
Bidder: tone -Contractors North Inc.
By: VP of South Bend Area 4/13/2021
^if.awk7Dustin Hilary (Title) (Date)
4/Irm C. Lee Construction Services, Inc.
Owner or Contact at MBE Firm Frederick "Chip" Lee
Telephone: 219-888-9554 Fax: 219-888-9564 Email: chip@cleecsi.com
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Hauling - Materials
RESULTS OF CONTACT WITH THE MBE FIRM:
We'll lease C. Lee Construction Services, Inc. for hauling if we are awarded the project.
MBE Firm Highway Safety Services. Inc.
_
Owner or Contact at MBE Firm -Doug Nagel
Telephone: 765474-1000 Fax: 765-446-1502 Email: doug.nagel@hss-mmco.com
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Traffic Control - MOT
RESULTS OF CONTACT WITH THE MBE FIRM:
Did not submit a quote as the project is too far away and the scope of work is too small.
Version 01/13/2021 Contractor's Bid for Public Works - 14
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MWBE-2.1
MWBE CONTACTED
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects
requiring 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 2 OF 2
Project Number: 120-069 MBE Participation Goal 3.9%
Project Name: Cor
Bidder ile ne
By:
Crossings Round 2
ers North. Inc.
VP of South Bend Area 4/13/2021
(Title) (Date)
ivigst rirm Victory Trucking, Inc. dba Three Rivers Barricade
Owner or Contact at MBE Firm Eldon Bvler
Telephone: 260-436-1611 Fax: Email: eldonb&3riversbarricade.net
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Traffic Control - MOT and Pavement Markinas
RESULTS OF CONTACT WITH THE MBE FIRM:
Did not submit a quote as the project is too far away and the scope of work is too small.
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
CITY OF SOUTH BEND
Qx'
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN1;
f•'
FORM MWBE-2.1
MWBE CONTACTED
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects
requiring 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 1 OF 3
Project Number: 120-059 WBE Participation Goal 5.9%
Project Name:
Bidder: ,ram
By:
Community Crossi
one Contractors Nor
Dustin Hilary
Round 2
Inc.
(Title)
4/13/2021
(Date)
WBrKFirm V & R Trucking, Inc.
Owner or Contact at WBE Firm Veda Godette
Telephone: 574-234-1268 Fax: 574-234-0748 Email: rfightingirish@aol.com
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Hauling - Materials
RESULTS OF CONTACT WITH THE WBE FIRM:
We will lease with V & R Trucking, Inc. for hauling if we are awarded the project.
WBE Firm Slusser's Green Thumb, Inc.
Owner or Contact at WBE Firm Shelle Shaw
Telephone: 574-722-3102 Fax: Email: sjs@slussers.com
TYPE OF WORK SOLICITED FOR THIS PROJECT -
Seed & Sod
RESULTS OF CONTACT WITH THE WBE FIRM:
Firm declined to submit a quote as there is no work for them on the project.
Version 01/13/2021 Contractor's Bid for Public Works - 15
CITY OF SOUTH BEND '
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MWBE-2.1
MWBE CONTACTED
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects
requiring 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 2 OF 3
Project Number: 120-059 WBE Participation Goal 5.9%
Project Name: 20 Communi Crossin s Round 2
Bidder* stone Contractors North, Inc.
i
By: VP of South Bend Area 4/13/2021
i ture) Dustin Hilary (Title) (Date)
Firm Traffic Control Specialists, Inc.
Owner or Contact at WBE Firm Barry Triska
Telephone: 574-772-7001 Fax: 574-772-7002 Email: barrygtcspecialists.net
TYPE OF WORK SOLICITED FOR THIS PROJECT.
Pavement Markings
RESULTS OF CONTACT WITH THE WBE FIRM:
TCS submitted quote, however, they were nearly 260% higher than the other quote obtained locally. We
chose to use the lower quote in our bid.
WBE Firm State Barricading. Inc.
Owner or Contact at WBE Firm James Michalski
Telephone: 574-287-2078 Fax: 574-287-2078 Email: statebarricade1(Maol.com
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Traffic Control Devices
RESULTS OF CONTACT WITH THE WBE FIRM:
We'll subcontract with State Barricading, Inc. for their work if are awarded the Droiect.
Version 01/13/2021 Contractor's Bid for Public Works -15
TH
;r
CITY OF SOUTH BEND , x
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN 1y `p CEO 2'
FORM MWBE-2.1
MWBE CONTACTED
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects
requiring 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 3 OF 3
Project Number: 120-069 WBE Participation Goal 5.9%
Project Name:
Bidder:
By:
Community Crossings Round 2
ine Contractors North, Inc.
re) uustin hoary
(Title)
4/13/2021
(Date)
W5F� ,=irm Hawk Enterprises, Inc.
Owner or Contact at WBE Firm Greg Neulieb
Telephone: 219-662-8090 Fax: 219-662-8093 Email: greg@hawk-inc.com
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Electrical
RESULTS OF CONTACT WITH THE WBE FIRM:
Firm declined to submit a auote as there was no work for them.
WBE Firm
Owner or Contact at WBE Firm
Telephone: Fax:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OF CONTACT WITH THE WBE FIRM:
Email:
Version 01/13/2021 Contractor's Bid for Public Works - 15
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
RESPONSIBLE BIDDER CHECKLIST
Project Name 2020 Community Crossings Round 2
Project No. 120-059
For Bids Due April 13, 2021, 9:00 a.m., Local Time
Contractor Name: Milestone Contractors North, Inc.
The City seeks to enhance its ability to identify responsive and responsible bidders on all City public works
projects by institution of comprehensive submission requirements in compliance with State law. Quality
workmanship, efficient operation, safety, and timely completion of projects requires that all bidders meet
certain minimum requirements to be responsive and responsible bidders.
THIS FORM MUST BE SUBMITTED WITH YOUR BID.
INSTRUCTIONS:
If you are a pre -qualified bidder, complete Section I only.
If you are not a pre -qualified bidder, complete Section II only.
Section II acts as an application for pre -qualification. Submission of Section II will allow the bidder to be
considered for pre -qualification for bids with the City of South Bend Department of Public Works. Pre -
qualified bidders will then be exempt from a portion of the submission requirements outlined in Section 6-
63 of The Responsible Bidding Ordinance No. 10594-18 (hereinafter, "Responsible Bidding Ordinance")
for a period of twelve (12) months.
Thereafter, contractors who are pre -qualified must submit a complete application for continuation of "pre -
qualified" standing, on a form provided by the City ("Responsible Bidder Checklist (1) Pre -Qualified
Bidders") by December 31st 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) Acknowledgements:
(i) X By checking this box, I hereby acknowledge that I am a pre -qualified bidder with
the City of South Bend and that I have met the pre -qualification requirements within
the last twelve (12) months. A copy of my Pre -Qualification verification letter
is attached.
(ii) X By checking this box, I hereby acknowledge that the City reserves the right to
request supplemental information, additional verification of any information
provided by me, and may also conduct random inquiries of my current and prior
customers.
(b) Attachments:
(i) X Indiana Secretary of State's on-line records (ie. Business verification) dated within
sixty (60) days of the submission of said document showing that business is in
existence, current with the Indiana Secretary of State's Business Entity Report,
and eligible for a certificate of good standing. (Not applicable to individuals, sole
proprietors or partnerships).
(ii) X Statement on staffing capabilities, including labor sources. This statement
indicates and ensures I have sufficient employees on staff to complete the work. It
outlines how I intend to meet the staffing needs of the work.
(iii) X List of projects of similar size and scope of work performed in all areas, including
the State of Indiana, within the last three (3) years.
(iv) X For every project, submit evidence of participation in apprenticeship and training
programs, applicable to the work to be performed on the project, which are
approved by and registered with the United States Department of..Labor's Office of
Apprenticeship, or its successor organization.
Version 01/13/2021 General Conditions - 8
PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED)
(a) Acknowledgements:
(i) _ By checking this box, I hereby acknowledge that I am not a pre -qualified bidder
with the City of South Bend.
(ii) _ By checking this box, I hereby acknowledge that the City reserves the right to
request supplemental information, additional verification of any information
provided, and may also conduct random inquiries of my current and prior
customers. The City reserved the right to utilize all information provided in this
submission and all information obtained in inquiries or requests to determine if a
bidder is responsive and responsible. Additionally, I acknowledge that all
information provided to the City shall be regarded as public records.
(iii) _ By checking this box, I hereby acknowledge that copies of all Applicable
apprenticeship certificates or standards for training programs applicable to the
work performed on the project may be requested at any time and shall be furnished
upon request.
(iv) _ By checking this box, I hereby acknowledge and ensure that I and all sub-
contractors, from whom I have accepted a bid and/or intend to hire to perform work
on the public work project, are properly licensed. Furthermore, I acknowledge my
understanding that it is my responsibility to ensure that all sub -contractors have
the necessary licenses to undertake the work called for in this bid. If a sub-
contractor loses their license at any point, it is the responsibility of that sub-
contractor to notify the City.
(b) Attachments:
(i)
Indiana Secretary of State's on-line records (ie. Business verification) dated within
sixty (60) days of the submission of said document showing that business is in
existence, current with the Indiana Secretary of State's Business Entity Report,
and eligible for a certificate of good standing. (Not applicable to individuals, sole
proprietors or partnerships).
List identifying all former business names.
Any determinations by a court or governmental agency any violations of federal
state, or local laws including, but not limited to, violations of contracting or antitrust
laws, tax or licensing laws, environmental laws, Occupational Safety and Health
Act (OSHA), or federal Davis -Bacon and related Acts, within the preceding five (5)
years.
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.
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.
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.
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.
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
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.
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: 4/13/202
(Sign�erD s
(rj4Kt Name Here)
Milestone Contractors_ North. I
(Name of Company)
24358 SR 23
(Address of Company)
South Bend
(City)
India)
(State)
574-288-4811
(Telephone Number)
�111111fill,
actors
..
9ORATc
VN
4ll11111111111N
Version 01/13/2021 General Conditions - 10
Responsible Bidding Practices and Submission
Requirements for Pre -Qualified Bidder Checklist
(b) Attachments
(i) Attached
Staffing Capabilities: Milestone Contractors North, Inc. is signatory with the
following unions which supply our workforce — Laborers International Union,
Teamsters, Operating Engineers and Cement Masons.
(iii) See Forms 96 and 96a
(iv) All individuals who will perform worn on the public works project on behalf of
Milestone Contractors North, Inc. will be properly classified under applicable state
and federal laws and local ordinances.
Dated: AnHI 13.2021
CZ H U B E3` Surety O+ 908.903.3485
202B Halls Mill Road, PO Box 1650 F + 908.903.3656
Whitehouse Station, NJ 08889-1650
Federal Insurance Company
AIA Document A31OTM - 2010 Bid Bond
Any singular reference to Contractor, Surety, Owner or other party shall be considered plural where applicable.
CONTRACTOR
(Name, Iegal status and address):
Milestone Contractors North, Inc.
24358 State Road 23
South Bend, IN 46614
OWNER
(Name, legal status and address):
City of South Bend
227 West Jefferson Boulevard
South Bend, IN 46601
BOND AMOUNT 5% Five Percent of the Total Bid
PROJECT
(Name, location or address, and Project number, if any)
2020 Community Crossings Round 2, Project No. 120-059
SURETY
(Name, legal status and principal place of business):
Federal Insurance Company
202B Halls Mill Rd., PO Box 1650
Whitehouse Station, NJ 08889-1650
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 speed in the bid documents, or within such time period as may be agreed to by the Owner and
Contractor, and the Contractor either (1) enters into a contract with the Owner in accordance with the terms of such
bid, and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a surety admitted
in the jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contract
and for the prompt payment of labor and material furnished in the prosecution thereof; or (2) pays to the Owner the
difference, not to exceed the amount of this Bond, between the amount specified in said bid and such larger amount
for which the Owner may in good faith contract with another party to perform the work covered by said bid, then this
obligation shall be null and void, otherwise to remain in full force and effect. The Surety hereby waives any notice of
an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver
of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for
acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for
an extension beyond sixty (60) days.
If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall
be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor.
Printed in cooperation with theAmerican Institute of Architects (AIA) by Chubb. The language in this document conforms to the language used in
AIA Document MIO TM- 2010.
Form 15-02-0575•FED (Rev. 3117)
When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the Project,
any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted here
from and provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein.
When so furnished, the intent is that this Bond shall be construed as a statutory bond and not as a common law
bond.
Signed and sealed this 13th day of April, 2021
MilestoZeCQractor5 i44odh, Inc.
(witness) Alisha Krueger
(witness) Jackie Dolce
r"Dustin Hilary
`,� 1111tt1��
TclVice
�`actors zi
President
o ' LpVORg•%
(Title)
:. SEAL :' n
���ss, • b'AIV1Q�X
(CO
Fede Insurance Company a
By:
(Attorney -in Farr) Angela M. Riley
(CorporateSeal)
Printed in cooperation with theAmerican Institute of Architects OM) by Chubb. The language in this document conforms to the language used in
AM DocumentA310 TK- 2010.
Form 15-02-0575-FED (Rev.3/17)
CHUaso
Power of Attorney
Federal Insurance Company I Vigilant Insurance Company I Pacific Indemnity Company
Westchester Fire Insurance Company I ACE American Insurance Company
Know All by These Presents, that FEDERAL INSURANCE COMPANY, an Indiana corporation, VIGILANT INSURANCE COMPANY, a New York corporation, PACIFIC INDEMNITY
COMPANY, a Wisconsin corporation, WESTCHESTER FIRE INSURANCE COMPANY and ACE AMERICAN INSURANCE COMPANY corporations of the Commonwealth of
Pennsylvania, do each hereby constitute and appoint Angela M. Riley
Surety Bond Number; Bid Bond
Obligee: City of South Bend
each as their true and lawful Attorney -in -Fact to execute under such designation in their names and to affix their corporate seals to and deliver for and on their behalf as surety
thereon or otherwise, bonds and undertakings and other writings obligatory in the nature thereof (other than bail bonds) given or executed in the course of business, and any
instruments amending or altering the same, and consents to the modification or alteration of any instrument referred to in said bonds or obligations.
in Witness Whereof, said FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, PACIFIC INDEMNITY COMPANY, WESTCHESTER FIRE INSURANCE COMPANY
and ACE AMERICAN INSURANCE COMPANY have each executed and attested these presents and affixed their corporate seals on this le day of November, 2019.
' " h
Dawn M. Chloros, Assistant Secretary
STATE OF NEW JERSEY
County of Hunterdon SS.
Stephen M. Haney, Vice President
On this 1-t day of November, 2019, before me, a Notary Public of New Jersey, personally came Dawn M. Chloros and Stephen M. Haney, to me known to be Assistant Secretary and
Vice President respectively, of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, PACIFIC INDEMNITY COMPANY, WESTCHESTER FIRE INSURANCE COMPANY
and ACE AMERICAN INSURANCE COMPANY, the companies which executed the foregoing Power of Attorney, and the said Dawn M. Chloros and Stephen M. Haney, being by me duly
sworn, severally and each for herself and himself did depose and say that they are Assistant Secretary and Vice President respectively, of FEDERAL INSURANCE COMPANY,
VIGILANT INSURANCE COMPANY, PACIFIC INDEMNITY COMPANY, WESTCHESTER FIRE INSURANCE COMPANY and ACE AMERICAN INSURANCE COMPANY and know the
corporate seals thereof, that the seals affixed to the foregoing Power of Attorney are such corporate seals and were thereto affixed by authority of said Companies; and that their
signatures as such officers were duly affixed and subscribed by like authority.
Notarial Seal *�
KATHMNE d. AOEtAAR
OTAq
NOTARY pugs OF NE W46ROZY
AIfBL1C
Na 2316M
CorrrNnlon DElrms July 16.20H Prase
�
CERTIFICATION
Resolutions adopted by the Boards of Directors of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY on August 30, 2016,
WESTCHESTER FIRE INSURANCE COMPANY on December 11, 2006; and ACE AMERICAN INSURANCE COMPANY on March 20, 2009:
'RESOLVED, that the following authorizations relate to the execution, for and on behalf of the Company, of bonds, undertakings, recognizances, contracts and other written commitments of the Company
entered into in the ordinary course of business (each a'Written Commltment7):
(1) Each of the Chairman, the President and the Vice Presidents of the Company is hereby authorized to execute any Written Commitment for and on behalf of the Company, under the
seal of the Company or otherwise.
(2) Each duly appointed attorney -in -fact of the Company Is herebyauthorlud to execute any Written Commitment for and on behalf of the Company, under the seal of the Company or otherwise,
to the extent that such action is authorized by the grant of powers provided for In such person's written appointment as such attorney -In -fact
(3) Each of the Chairman, the President and the Vice Presidents of the Company is hereby authorized, for and an behalf of the Company, to appoint in writing any person the attorney -in -
fad of the Company with full power and authority to execute, for and on behalf of the Company, under the seal of the Company or otherwise, such Written Commitments of the
Company as may be spedfied In such written appointment which specification may be by general type or class of Written Commitments or by specification of one or more particular
Written Commitments.
(4) Each of the Chairman, the President and the Vice Presidents of the Company Is hereby authorized, for and on behalf of the Company, to delegate in writing to any other officer of the
Company the authority to execute, for and on behalf of the Company, under the Companies seal or otherwise, such Written Commitments of the Company as are specified in such
written delegation, which specification may be by general type or class of Written Commitments or by specification of one or more particular Written Commitments.
(5) The signature of any officer or other person executing any Written Commitment or appointment or delegation pursuant to this Resolution, and the sal of the Company, may be affixed by
facsimile on such Written Commitment or written appointment or delegation.
FURTHER RESOLVED, that the foregoing Resolution shall not be deemed to be an exclusive statement of the powers and authority of officers, employees and other persons to act for and on behalf of the
Company, and such Resolution shall not limit or otherwise affect the exercise of anysuch power or authority otherwise validly granted or vested."
I, Dawn M. Chloros, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, PACIFIC INDEMNITY COMPANY, WESTCHESTER FIRE INSURANCE
COMPANY and ACE AMERICAN INSURANCE COMPANY (the "Companies") do hereby certify that
(i) the foregoing Resolutions adopted by the Board of Directors of the Companies are true, correct and in full force and effect,
(fi) the foregoing Power of Attorney is true, correct and in full force and effect ,r
Given under my hand and seals of said Companies at Whitehouse Station, NJ, this April® 3a2021.
-
y 1
♦ Ja♦
Dawn M. Chloros, Assistant Secretary
PLEASE CONTACT US AT:
Combined: FED-VIO-PI-WFIC-AAIC (rev. 11-19)
sir ::;,! t rifirfidt, e
Part of State Form52414 (R212-13) Form 96 (Revised 2013)
BID OF
Milestone Contractors North, Inc.
(Contractor)
(Address)
South Bend. IN 46614
FOR
PUBLIC WORKS PROJECTS
OF
City of South Bend, Indiana
2020 Community Crossings Round 2
Proiect No. 120-059
Filed April 13th, 2021
Action take
Prescribed by State Board of Accounts
State Form 52414 (R / 9-10)
Form No. 96 (Revised 20V
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): _ April 13th, 2021
City of South Bend, Indiana
St. Joseph
Milestone Contractors North. Inc.
24358 SR 23
South Bend_ IN 46614
(574) 288-4811
Pursuant to notices given, the undersigned offers to famish 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 Department of Public Works — City of South Bend and dated March 11 , 2021 for the sum of
See Attached $ See Attached.
The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the notice of
the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the notice. Any
addendums attached will be specifically referenced at the applicable page.
If additional units of material included in the contract are needed, the cost of units must be the same as that shown
in the original contract if accepted by the Governmental Unit. If the bid is to be awarded on a unit basis, the itemization of
the units shall be shown on a separate attachment.
The Contractor and his subcontractors, if any, shall not discriminate against or intimidate any employee, or
applicant for employment, to be employed in the performance of this contract, with respect to any matter directly or
indirectly related to employment because of race, religion, color, sex, national origin or ancestry. Breach of this covenant
may be regarded as a material breach of the contract.
CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS
(If applicable)
I, the undersigned bidder or agent as a contractor on a public works project, understand my statutory obligation to
use steel products made in the United States. I.C. 5-16-8-2. I hereby certify I and all subcontractors employed by me for
this project will use U.S. steel products on this project if awarded. I understand that violations hereunder may result in
forfeiture of contractual payments.
2
ACCEPTANCE
The above bid is accepted this day of
Contracting Authority Members:
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): April , 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
May 2019 Walsh Construction
$ 12,170,428
Reconstruction
$ 5,489,454
Resurface
November 2019
Lake Counly Hwy Dept
$ 4,356,212
Resurface
December 2019
City 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?
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. 881 Dr., Merrillville, IN 46410 Mr. Raymond 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
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
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
Asphalt Plants
DESCRIPTION,
SIZE, CAPACITY,
ETC.
CONDITION
YEARS
OF
SERVICE
PRESENT LOCATION
5
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
I Griffith, South Bend
7
LowBoy Tractors
Various
Good
Griffith, South Bend
9
Flatbed Dumps
Various
Good
Griffith, South Bend
54
% 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
4. What equipment do you have available to use for the proposed project? Any equipment to be used by subcontractors
may also be required to be listed by the governmental unit.
5. Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing
your proposal? Otherwise, please explain the rationale used which would corroborate the prices listed.
Yes, we received quotes from potential subcontractors and suppliers
4
SECTION III CONTRACTOR'S FINANCIAL STATEMENT
Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial statement as required
by statute shall thereby be rendered invalid. The financial statement provided hereunder to the governing body awarding
the contract must be specific enough in detail so that said governing body can make a proper determination of the bidder's
capability for completing the project if awarded.
SECTION IV CONTRACTOR'S NON -COLLUSION AFFIDAVIT
The undersigned bidder or agent, being duly sworn on oath, says that he has not, nor has any other member,
representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination,
collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person
from bidding nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and
without any agreement, understanding or combination with any other person in reference to such bidding.
He further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate,
fee, gift, commission or thing of value on account of such sale
SECTION V OATH AND AFFIRMATION
I HEREBY AFFIRM 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 13th day
���X�,tra'cto%j M 's
o •LC)RPORATf•�~�� B
a,:
SEAL : "
.,
. ' � stin Hilar
°B`r Vn I►C►N%
ACKNOWLEDGEMENT
STATE OF Indiana 1
) ss
COUNTY OF St. Joseph }
2021.
3 North, Inc.
of Organization)
(Title of Person Signing)
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 I P
day of April,. 2021.
lisha Krueger, Notary blic
My Commission Expires: June 5, 2022
ALISHA KRUEGER
Notary Public, State of Indiana
SEAL;"St. Joseph County
County of Residence: St. Joseph
My Commission Expires
June 06, 2022
Form 96 Section II, #2
Subcontractors Used on Public Works Contracts
the Past 5 Years
SUBCONTRACTORS
COMPANY ADDRESS CITY/STATE/ZIP PHONE FAX
SEWER
B&DSewer
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 Comoanv
ELECTRICAL INSTALLATION
Hawk Enterprises
Midwestern Electric
S/T Bancroft Electric
Sweney Electric Company
Trans Tech Electric
SIGN INSTALLATION
Hawk Enterprises
Midwestern Electric
RoadSafe Traffic Systems
State Barricading, Inc.
Traffic Control Specialists, Inc.
PAVEMENT MARKINGS
The Airmarking Company
Blackout Sealcoating
RoadSafe Traffic Systems
State Barricading, Inc.
Traffic Control Specialists, Inc.
Traffic Management Company
TRAFFIC CONTROL
RoadSafe Traffic Systems
Traffic Control Specialists, Inc.
Traffic Management Company
LANDSCAPE
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
(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
(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
8795339
3113 Holmans Lane
Jeffersonville, IN 47130
(812) 725-8665
(812) 725-8672
13476 Britton Park Rd.
Fishers, IN 46038
(317) 841-8364
(317) 841-0075
6200 W. Hwy 62, Ste 400 Jeffersonville, IN 47130
(812) 282-2751
(812) 283-9846
209 Quality Ave. Ste 9
New Albany, IN 47150
(812) 941-0252
(812) 941-0852
9350 E. 30th St.
Indianapolis, IN 46229
(317) 594-0291
(317) 594-0271
1850 E. North St
1620 E. Chicago Ave
25020 State Road 2
9111 Louisiana St.
4601 Cleveland Road
1850 E. North St
1620 E. Chicago Ave
3122 Olympia Dr
24963 U.S. Highway 20
1810 W Pacific Avenue
P.O. Box 526
7440 W. 87th Place
3122 Olympia Dr
24963 U.S. Highway 20
1810 W Pacific Avenue
3542 Hiqhwav Avenue
3122 Olympia Dr
1810 W Pacific Avenue
3542 Highway Avenue
Crown Point, IN 46307
East Chicago, IN 46312
South Bend, IN 46619
Merrillville, IN 46410
South Bend, IN 46619
Crown Point, IN 46307
East Chicago, IN 46312
Lafayette, IN 47909
South Bend, IN 46628
Knox, IN 46534
Rochester, IN 46975
Bridgview, IL 60455
Lafayette, IN 47909
South Bend, IN 46628
Knox, IN 46534
Highland, IN 46322
Lafayette, IN 47909
Knox, IN 46534
Highland, IN 46322
Great American Landscape P.O. Box 235 Dyer, IN 46311
Hubinger Landscape 210 E. 113th Avenue Crown Point, IN 46307
Slusser's Green Thumb, Inc. 125 Montgomery Street Logansport, IN 46947
(219) 662-8090
(219) 397-4444
(574) 287-6490
(219) 769-6007
(574) 272-9673
(219) 662-8090
(219) 397-4444
(317) 780-1825
(574) 287-2078
(574)772-7001
(219) 662-8093
(219) 397-8888
(219) 769-0565
(574) 271-0144
(219) 662-8093
(219) 397-8888
574) 772-7002
(574) 223-5817 (574) 223-7959
(219) 864-2300 (708) 430-6910
(317) 780-1825
(574) 287-2078
(574)772-7001 (574)772-7002
(291)746-2433
(317) 780-1825
(574)772-7001 (574)772-7002
(219) 746-2433
(219) 322-7033
(219) 662-9911
(574)722-3102
(219) 322-4419
(219) 662-6206
(574) 722-1628
T & J Landscape Service 8253 Wicker Avenue St. John, IN 46373 (219) 374-9900 (219) 374-9950
GUARDRAIL/FENCING
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
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
Gilmer Trucking
20390 New Road
South Bend, IN 46614
(574) 229-3233
i
Material I ranster Inc.
1811 West 101st Ave.
Grown Point, IN 46307
(219) 865-9575
Morris Motor Service, Inc.
10525 W US Hwy 30 Bld
Wanatah, IN 46390
(219) 733-9430
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
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
7
General Form No. 96-a
Prescribed by the State Board of
Accounts of Indiana. Revised 1949.
Standard Questionnaires and
I' inancial 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 Cite of South Bend, Indiana
By Milestone Contractors North, Inc.
fA Corporation
Address 1700 E. Main St, Griffith, IN 46319
Date submitted April 13t", 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 information 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 fmd 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. HINDMAN,
State Examiner
CITY OF SOUTH BEND JAWS MUELLF.R, MAYOR
DEPARTMENT OF PUBLIC WORKS
ERIC HORVATH, DIRECTOR
September 23, 2020
Mr. Dustin Hilary
Walsh & Kelly, Inc.
dhilarvrZ_t?walshkellN .com
RE: Pre -Qualification Verification
Dear Mr. Hilary:
This letter serves as verification of Pre -Qualification status of your company for bidding
with the City of South Bend. This Pre -Qualification status is effective for twelve (12)
months from the date of this letter. Thereafter you are required to re -submit a complete
application for continuation of pre -qualification status prior to December 31 for the
upcoming calendar year.
A copy of this Verification Letter must be included with every bid exceeding $150,000
submitted to the City of South Bend Board of Public Works, along with your Pre -Qualified
Bidder Checklist and attachments.
If you have any further questions regarding this matter, please call this office at (574) 235-
9251.
Sincerely,
�M 1�e9 W laxar9m
Liz Horvath�w,
Oabc29lG-093] 11iLi9-09LP
Liz Horvath, Permit Manager
1/10/2016 2:42 PA FROM: MOEITS TO: •12189248768 P. 8
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QQI N �` ,�••s� V Dcsr Sir or Madam:
4 Qj O m A At the negwdof Wdsb & Kelly Inc, I am pmviding you with evidmw@ of dwCceepWs
ill oomplisxe with the epprmsionhip requircmenh In 30 D.CS S00/30,7Z(� ottbe Illfrofs
``p� .• .(, Procurement Code. 1 om wbmittng We Ir2ter siomg with apprenticeship eoniitmres
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��I•• °' n• r 15%AFLCIO. Walsh & Kelly Inc, is required by Copea> n8�ml ive to
Cif 0. lr sil�,.i pwftpts(nsnspplimbkeppnmtmshtpand uainingprog— ppcwadMand
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-0 Tmininy The uIrAched certillicalas erg evidence of=nplience with the U.S. Department
0 ca }' idnr ofLabor•s apprmtieahip hequirernmas.
b af Thaeh you derynur emperston in dds matter. If you heveauy glustiom ormtuems
c, D O i1!; plmte do Dot hesitsta to emthm me.
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vim[ Very WlY Yours,
q' CIA , . � � IU08, laed ISa AFL•CIO
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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
MILESTONIE 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•6r authorized to transact business in the State of
`'
Indiana on March 16, 2021.
I further certify this Domestic For -Profit Corporation has filed its most recent report required by
Indiana law with the Secretary of State, or is not yet required to.file such report, and that no notice of
withdrawal, dissolution, or expiration has beeWfiled or taken place. All fees, taxes, interest, and
penalties owed to Indiana by the domestic or foreign entity and collected by the Secretary of State
have been paid.
In Witness Whereof, I have caused to be affixed my
signature and the seal of the State of Indiana, at the City
of Indianapolis, March 16, 2021
drx4ci-00 0%- ""M
f�IiPrl�►1I�[��iPl
SECRETARY OF STATE
194484-057 / 20211917617
All certificates should be validated here: https:Hbsd.sos.in.gov/ValidateCertificate
Expires on April 15, 2021.
State of Indiana
Office of the Secretary of State
Certificate of Amendment
of
1 ALSH & 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.
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
&m4e-�Wo clj""47�,
CONNIE LAWSON
SECRETARY OF STATE
194484-057 / 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 beerVoMsented to me at my office, accompanied by the fees
prescribed by law and that the documentation presented conforms..toiaw as prescribed by the provisions
of the Indiana Code. -
Following said transaction, the above named' -entity uvill transact business under tl a assumed business
name(s) of:
WALSff-W KELLY..
Tit ?",
NOW, THEREFORE, with this; document I certify that Said transaction will become effective Monday,
February 01, 2021. i4_:
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-aS7/8978234
To ensure the certificate's validity, go to https:Hbsd.sos.in-gov/PublicBusinessSearch
Form , -a¢ I Request for Taxpayer
(Rev. October2018) 1 Identification Number and Certification
Department of the Treasury i
Internal Revenue Service ► Go to www.1rls.gov/FormW9 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 One blank.
MILESTONE CONTRACTORS NORTH, INC.
2 Business name/disregailded entity name,
WALSH & KELLY, INC.
Give Form to the
requester. Do not
send to the IRS.
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 1 4 Exemptions (codes apply only to
following seven boxes, certain entities, not Individuals; see
instructions on page 3):
❑ Individuallsole proprietor or ❑ C Corporation El S Corporation ❑ Partnership ElTrustiestete
single -member LLC Exempt payee code (I any)
❑ Umited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ►
Note: Check the appropriate box In the line above for the tax classification of the single -member owner. Po not check Exemption from FATCA reporting
LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC Is code (if any)
another LLC that Is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
L_J Other (see instructions) ►
5 Address (number, street, and apt. or suite no.) See instructions.
1700 EAST MAIN STREET
, state, and ZIP code
FITH, IN 46319
account number(s)
rMadn Ica =cwzft mmmwnadauWde tlm u.S1
f Requester's name and address (optional)
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 instructions
number (Safer However, fora _ 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 F71
FTM
TIN, later, or
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and L Employer Identificatlon number
Number To Give the Requesterfor guidelines on whose number to enter.
3 5-[T12 0 6 8 5'
1 !
" Certification _
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am wafting 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 QRS) 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.
awn Signature of
Here u.s.person► Data► 2' 1q 2,OV
General Instructions
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.gov1FonnW9.
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 QM), 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)
• Form 1099-DIV (dividends, including those from stocks or mutual
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 1099-8 (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 77N, 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 roles 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 11/412020
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.
1 Tracy L. Cross, Ex tive Secretary
Certification Board
DAPW PQ2 State Form 3963R Rev. 07/06
WRITTEN CONSENT TO RESOLUTIONS
of the
BOARD OF DIRECTORS
of
WALSH & KELLY, INC.
The undersigned, being all of the Directors of WALSH & KELLY, INC., an Indiana Corporation,
hereby consent to the following actions to be taken by the Corporation without a meeting of the Board of
Directors under the applicable provisions of the Indiana Business Corporation Law, as amended:
RESOLVED that the following be, and hereby are, elected officers of the Corporation, to
hold the office until the next regular meeting of the Board of Directors and until their
successors are duly elected and have qualified: ,
John M. Peisker, President
Jeffrey L. Swan, Executive Vice President
John P. Vercruysse, Executive Vice President
Jamie L. Tancos, Vice President of Finance, Secretary & Treasurer
Gregory A. Kelly, Vice President
Charles Potts Jr., Vice President
Albert E.VanDenBergh, Vice President
David L. Franz, Vice President
David J. Misirly, Vice President
Gregory A. Hoffman, Vice President
Dustin P. Hilary, Vice President
Lynn J. Bauer, Vice President
Mark E. Krachenfels, Vice President
RESOLVED FURTHER that the actions of the Officers of the Corporation taken since the
last meeting of the Board of Directors be, and the same hereby are, fully ratified and
approved.
RESOLVED FURTHER that the following be, and they hereby are, authorized to execute
all contracts or similar documents on behalf of the Corporation:
John M. Peisker, President
Jeffrey L. Swan, Executive Vice President
John P. Vercruysse, Executive Vice President
Jamie L. Tancos, Vice President of Finance, Secretary & Treasurer
Gregory A. Kelly, Vice President
Charles Potts Jr., Vice President
Albert E.VanDenBergh, Vice President
David L. Franz, Vice President
David J. Misirly, Vice President
Gregory A. Hoffman, Vice President
Dustin P. Hilary, Vice President
Lynn J. Bauer, Vice President
Mark E. Krachenfels, Vice President
RESOLVED FURTHER that this consent shall be in lieu of an annual meeting of the Board
of Directors of the Corporation and shall be filed in the minute book of the Corporation in
place of any such annual minutes.
<<SIGNATURES ON THE NEXT PAGE>>
EXECUTED this 15t' day of January, 2020.
Fred Feh e feld, Jr.
Albert E. VanDenBergh
Kevin J. Kelly
James Fehsenfeld
hJI P.V-.,= � � �
n P. Vercruysse
EXECUTED this 15th day of January, 2020.
Fred Fehsenfeld, Jr.
Albert E. VanDenBergh
Kevin J. Kelly
James C. Fehsenfeld
John P. Vercruysse
EXECUTED this 15' day of January, 2020.
Fred Fehsenfeld, Jr.
James C. Fehsenfeld
Albert E. VanDenBergh John P. Vercruysse
Kein;T'K—elly�—"
'i
P,il 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 Po s, Chief Operating Officer
Margaret Garner, HR Area Partner/EEO Officer
February 2021
EOE Aff/Vets/Disabled
P,i\ milesto
ne
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
m�arner . milestonelp.con�
(317)616-4937
CJ Potts, Chief Operating Officer
EOE M/FNets/Disabled
anlirwmtr of Quatirtadion
INDIANAPOLIS, IN
TO
WALSH & KELLY INC
ISSUED BY
of larmsp=tdim
May 21, 2020
GRIFFITH, IN
who has filed with the Department a Contractor's Statement of Experience and Financial Condition as
required under Indiana Code 8-23-10, is hereby qualified to bid at any Department of Transportation
letting in Classes of Work and within the amount and other limitation of each classification as listed
below, for such period as the uncompleted work on hand from all sources does not exceed the Aggregate
amount. Classification references by name or symbol are in accordance with the definitions in the
Contractor's Statement of Experience and Financial Condition. This certificate supersedes any certificate
previously issued, but is subject to revision or revocation according to the law, if and when changes
in the financial condition of the contracting firm or other facts justify such revision or revocation.
Valid May 21, 2020 Thru April 30, 2021
AGGREGATE....................................................................................................................................... $UNLIMITED
A(B) CONCRETE PAVEMENT: LIMITED......................................................................................................... $25,000,000
B(A) ASPHALT PVMT:W/INDOT CERTIFIED HMA PLANT..........................................................................$UNLIMITED
C(B) LIGHT GRADING........................................................................................................................................$UNLIMITED
E(E) SMALL STRUCTURES AND DRAINAGE ITEMS.................................................................................... $25,000,000
E(F) SURFACE MASONRY AND MISC CONCRETE....................................................................................... $50,000,000
E(G) TRAFFIC CONTROL: PAVEMENT MARKINGS...................................................................................... $25,000,000
E(H) DEEP SEWER AND/OR EXCAVATION.................................................................................................... $25,000,000
E(Q) CONCRETE PAVEMENT: REPAIRS......................................................................................................... $25,000,000
E(R) ASPHALT PAVEMENT MILLING.............................................................................................................. $50,000,000
1 I
PREQUALIFICATION ENGINEER
State Form 20508 (R3 / 5-05)
COMMISSIONER
PREQUALIFICATION WORKSHEET
PRINTED:
5/21/2020
PQA APPROVED:
5/7/2020
ACCT : # 35-1120685 ALT ACCT: # 0449 NEW? SUPP?
APPROVED BY:
�lL
NAME: WALSH & KELLY INC
Jf
DATE:
5/21/2020
December 31, 2019
CURRENT FIXED
EQUIPMENT
ASSETS REPORTED
------- ------------------------ -------------
$47,119,379.00 $10,219,627.00
S31,032,017.00
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 $4,759,016
$31,032,017
FIXED
$9,518,032.00
RATING FACTORS
X 10 X 2
X R
------------
- --- - -- -- ..............
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
BALANCE SHEET ANALYSIS
------ --- - ------------ ------ --
E(R)
$50,000,000
CURRENT ASSETS:
$47,119,378 CURRENT RATIO:
2.916
A(B)
$25,000,000
INVENTORY:
$4,,
2.668
E(Q)
$25,000,000
----------------- ----------------------------------016185-------
CURRENT LIABILITIES:
------------QUICKRATIO:----------------------------
$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
NET WORTH:
---------
$55,470,656
TOTAL LIABILITIES:
$32,900,364
NOTES: