HomeMy WebLinkAboutOpening of Bids - 2021 Asphalt Materials Bid - Project No. 121-026 - Milestone Contractors North, Inc.1316 COUNTY -CITY BUILDING
227 W.JEFFERSON BOULEVARD
SOUTH BEND, INDIANA 46601-1830
Date:
To:
From
Subject
Project Name
Project No.:
PHONE 574/235-9251
FAx 574/ 235-9171
TDD 574/ 235-5567
CITY OF SOUTH BEND JAMES MUELLER, MAYOR
BOARD OF PUBLIC WORKS
April 7, 2021
All Planholders
Anne Fuchs, Clerk, Board of Public Works
Addendum Number: 1
2021 Asphalt Material Bid
121-026
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM
Date Received: 4/7/2021
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: Milestone
Authorized Signature:
ilary, VP of South Bend Area
Date:
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CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
Project Name
Project No.
For Bids Due
CHECKLIST FOR BIDDERS
2021 Asphalt Material Bid
121-026
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 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 andmply with the specifications.
Bidder: M
By Authorized
Signature:
Print Name & Title:
VP of South Bend Area
Version 01/13/2021 Contractor's Bid for Public Works - 1
Date: 4/13/2021
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
Project Name
Project No.
For Bids Due
2021 Asphalt Material Bid
121-026
April 13, 2021, 9:00 a.m., Local Time
PART
(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: _(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:
of South Bend - 2021 AsDhalt Material Bid
the City of South Bend, Indiana, in accordance with plans and specifications prepared by:
Department of Public Works - City of South Bend
and dated March 19 & 26, 2021 for the sum of (enter the Total Bid as shown on the Proposal)
Two million four hundred five thousand eight hundred seventy five dollars and zero cents $ 2,405,875.00
(Enter sum of Total Base Bid plus Alternates shown on Proposal) (Numerical)
The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in
the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance
with the notice. Any addendums attached will be specificall erenced at the applicable page.
If additional units of material included in the contract are a , t cost of units must be the same as that
shown in the original contract if accepted by the Ci f uth end. If the bid is to be awarded on a unit
basis, the itemization of the units shall be shown a par attachment.
By
Bustin Hilary VP of Rmith RPnrl Area
(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 36-1-12-4)
These statements to be submitted under oath by each bidder with and as part of his/her/its bid.
Attach additional pages for each section as needed.
SECTION I EXPERIENCE QUESTIONNAIRE
1. Attach information regarding projects your organization has completed for the period of one
(1) year prior to the date of the current bid.
2. Attach a listing of public works projects currently in process of construction by your
organization.
3. Attach information regarding any failure to complete any work awarded to you and the
location thereof.
4. Attach references from private firms for which you have performed work.
SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE
1. Attach an explanation of your plan or layout for performing proposed work. (Examples could
include a narrative of when you could begin work, complete the project, number of workers,
etc. and any other information which you believe would enable the City of South Bend to
consider your bid.)
2. Attach a listing of the names and addresses of all subcontractors (i.e. persons or firms outside
your own firm who have performed part of the work) that you have used on public works
projects during the past five (5) years along with a brief description of the work done by each
subcontractor.
3. If you intend to sublet any portion of the work, attach the name and address of each
subcontractor, equipment to be used by the subcontractor, and whether you will require a
bond. However, if you are unable to currently provide a listing, please understand a listing
must be provided prior to contract approval. Until the completion of the proposed project, you
are under a continuing obligation to immediately notify the City of South Bend in the event that
you subsequently determine that you will use a subcontractor on the proposed project.
4. Attach a listing of equipment you have available to use for the proposed project.
5. Have you entered into contracts or received offers for all materials which substantiate the
prices used in preparing your proposal? If not, attach an explanation for the rationale used
which would corroborate the prices listed.
SECTION III CONTRACTOR'S FINANCIAL STATEMENT
Attachment of bidder's financial statement is mandatory. Any bid submitted without said
financial statement as required by statute shall thereby be rendered invalid. The financial
statement provided hereunder to the City of South Bend awarding the contract must be specific
enough in detail so that said City of South Bend can make a proper determination of the bidder's
capability for completing the project if awarded.
Version 01/13/2021 Contractor's Bid for Public Works - 3
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. Jose{]h COUNTY )
The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury
that:
1. Contractor has not, nor has any other member, representative, or agent of the firm, company,
corporation or partnership represented by him, entered into any combination, collusion or agreement with
any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding
nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and
without any agreement, understanding or combination with any other person in reference to such bidding.
Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or
indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and
2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals
are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
participation in this transaction by any Federal department or agency; and
3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in
investment activities in Iran.
a. For purposes of this Certification, "Iran" means the government of Iran and any agency
or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as
amended from time -to -time.
b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor
is engaged in investment activities in Iran if either:
i. Contractor, its successor or its affiliate, provides goods or services of twenty
million dollars ($20,000,000) or more in value in the energy sector of Iran;
or
ii. Contractor, its successor or its affiliate, is a financial institution that extends
twenty million dollars ($20,000,000) or more in credit to another person for
forty-five (45) days or more, if that person will (i) use the credit to provides
goods and services in the energy sector in Iran; and (ii) at the time the
financial institution extends credit, is a person identified on list published by
the Indiana Department of Administration.
Version 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 aft-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.
1, 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
Mi
der
ctors North. Inc.
7usti
e of ContractorBidder or Its Agent
Hilary, VP of South Bend Area
Printed Name and Title
Subscribed and sworn to before me this 13th day of ril , 2021
My Commission Expires 6/5/22 L 'd!fL Notary Public �AliKrueger
County of Residence _St. Joseph
""PYIP�'!�
ALISHA KRU EGE�RrvW'6
i
P
o •' :e<�', Notary Public, State of In.ui,,n.,
#..SEAL' =
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St. Joseph County
•i -. 4'••••Np �.
My Commission Expires
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June 05, 2022
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Version 01/13/2021 Contractor's Bid for Public Works - 6
BID/PROPOSAL
CITY OF SOUTH BEND
BID NAME 2020 Street and Sewer Department Materials
FOR BIDS DUE Aril 14, 2020, 9:00 a.m., Local Time
BASE BID - ASPHALT MATERIALS
Item
No.
Description
Quantity
Unit
A-1 HMA Surface Type B,
5000
TON
9.5mm, PG 64-28P
17500
TON
A-2 HMA Surface Type B,
9.5mm, PG 70-22P
22500
TON
A-3 HMA Binder 11
A-4 HMA Base 5D 3000 TON
A-5 CMA Patch AE-300P 500 TON
A-6 High Performance Cold Mix 150 EA
A-7 Driver and Truck 600 PER HR
Bidder (Firm): Milestone Contractors North, Inc.
Unit Price
$53.50
$52.75
$44.00
Total
$ 267,500.00
$ 923,125.00
$ 990,000.00
$ 108,750.00
$36.25
$65.00 $ 32,500.00
$100.00 $ 15,000.00
$115.00 $ 69,000.00
TOTAL $ 2,405,875.00
Address: 24358 SR 23
City/State/Zip: South Bend, IN 46614 Telephone Number: 4 288-4811
-1:` r%Vac�to sB
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. ••.2 .
�,oc,. �pRPORq f..°os ► (Signature)
T
Dustin Hilary VP of South Bend Area SEAL
•n
(Printed Name of Person Signing)
/ 41 N V I CN` %�����`
Version 01/13/2021 Contractor's Bid for Public Works - 7
H U E3 So Surety O+ 908.903.3485
202B Halls Mill Road, PO Box 1650 F + 908.903.3656
Whitehouse Station, M 08889-1650
Federal Insurance Company
AIA Document A31OTM - 2010 Sid Bond
Any singular reference to Contractor, Surety, Owner or other party shall be considered plural where applicable.
CONTRACTOR
(Name, legal 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)
2021 Asphalt Material Bid, Project No. 121-026
6 i1.7*"
(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 specified in the bid documents, or within such time period as may be agreed to by the Owner and
Contractor, and the Contractor either (1) enters into a contract with the Owner in accordance with the terms of such
bid, and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a surety admitted
in the jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contract
and for the prompt payment of labor and material furnished in the prosecution thereof, or (2) pays to the Owner the
difference, not to exceed the amount of this Bond, between the amount specified in said bid and such larger amount
for which the Owner may in good faith contract with another party to perform the work covered by said bid, then this
obligation shall be null and void, otherwise to remain in full force and effect. The Surety hereby waives any notice of
an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver
of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for
acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for
an extension beyond sixty (60) days.
If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall
be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor.
Printed in cooperation with the American Institute of Architects (AW by Chubb. The language in this document conforms to the language used in
AIADocument A= "m- 2010.
Form 15.02-0575-FED (Rev. 3/17)
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
(witness) Alisha Krueger
`1 r�
(witness) Jackie Dolce
day of April, 2021
North, Inc.
Dustin Hilary
111!1tl11N�'
,`,�
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Vice President
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�� ��0 CORPO"
(Title)
'�
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Federal Insurance Company J�
Inn ra n Inn
Angela M. Riley
(Corporate Seal)
Printed in cooperation with theAmerican Institute of Architects (AM) by Chubb. The language in this document conforms to the language used in
AM DocumentA310 Tu- 2010.
Form 15-02-0575•FED (Rev. 3/17)
CHUBBe
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 SR day of November, 2019.
Dawn M. Chloros, Assistant Secretary
c
��, �tt 4 g�� S R,'
STATE OF NEW JERSEY
County of Hunterdon SS.
,&jb,j- At d-c�
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 /tigil ` ;
htOTAgrI �1:
KAT11agIN! J. AOQMs
NOTARY PUBLIC OF NEW JERttf3Y
ter+ a
PUBLIC it
No. �1l086
CmmWealon Eh; I July 16, 2f144 Noury Rmbae
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 Commitment"):
(1) Each of the Chairman, the President and the Vice Presidents of the Company Is hereby authorized to execute any Written Commitment for and on behalf of the Company, under the
seal ofthe Company or otherwise.
(2) Each duly appointed attorney -in -fact of the Company Is hereby authorized to execute any Written Commitment for and on behalf of the Company, under the seal of the Company or otherwise,
to the extent that such action Is authorized by the 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 on behalf of the Company, to appoint In writing any person the attorney -In.
fact of the Company with fun power and authority to execute, for and on behalf of the Company, under the seal of the Company or otherwise, such Written Commitments of the
Company as may be specified In such written appointment which specification may be by general type or class of Written Commitments or by specification of one or more particular
Written 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 Company's seal or otherwise, such Written Commitments of the Company as are specified in such
written delegation, which specification may be by general type or class of Written Commitments or by specification 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 seal 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 afncers, employees and other persons to act for and on behalf of the
Company, and such Resolution shall not limit or otherwise affect the exercise of any such power or authority otherwise validly granted or vested'
L 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,
(if) the foregoing Power of Attorney is true, correct and in full force and effect 4
Given under my hand and seals of said Companies at Whitehouse Station, NJ, this.ApO1.11,1202.Ir A
Dawn M. Chloros, Assistant Secretary
71,
ANY OTHER MATTER, PLEASE CONTACT US AT:
mall: sure @chubb.com
1N THE EVENT YOU WISH TO VERIFY THE
Combined: FED-MG-PI-WFIC-AAIC (rev. 11-19)
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
RESPONSIBLE BIDDER CHECKLIST
Project Name 2021 Asphalt Material Bid
Project No. 121-026
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 31s' 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 - 5
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 - 6
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 - 7
PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED)
(a) Acknowledgements:
(i) _ By checking this box, I hereby acknowledge that I am not a pre -qualified bidder
with the City of South Bend.
(ii) _ By checking this box, I hereby acknowledge that the City reserves the right to
request supplemental information, additional verification of any information
provided, and may also conduct random inquiries of my current and prior
customers. The City reserved the right to utilize all information provided in this
submission and all information obtained in inquiries or requests to determine if a
bidder is responsive and responsible. Additionally, I acknowledge that all
information provided to the City shall be regarded as public records.
(iii) _ By checking this box, I hereby acknowledge that copies of all Applicable
apprenticeship certificates or standards for training programs applicable to the
work performed on the project may be requested at any time and shall be furnished
upon request.
(iv) _ By checking this box, I hereby acknowledge and ensure that I and all sub-
contractors, from whom I have accepted a bid and/or intend to hire to perform work
on the public work project, are properly licensed. Furthermore, I acknowledge my
understanding that it is my responsibility to ensure that all sub -contractors have
the necessary licenses to undertake the work called for in this bid. If a sub-
contractor loses their license at any point, it is the responsibility of that sub-
contractor to notify the City.
(b) Attachments:
(i) _
Indiana Secretary of State's on-line records (ie. Business verification) dated within
sixty (60) days of the submission of said document showing that business is in
existence, current with the Indiana Secretary of State's Business Entity Report,
and eligible for a certificate of good standing. (Not applicable to individuals, sole
proprietors or partnerships).
(ii) _
List identifying all former business names.
(iii) _
Any determinations by a court or governmental agency any violations of federal
state, or local laws including, but not limited to, violations of contracting or antitrust
laws, tax or licensing laws, environmental laws, Occupational Safety and Health
Act (OSHA), or federal Davis -Bacon and related Acts, within the preceding five (5)
years.
(iv) _
Statement about staffing capabilities, including labor sources. This statement
indicates and ensures I have sufficient employees on staff to complete the work I
am bidding on OR outlines how I intend to meet the staffing needs of the work.
(v) _
Statement that individuals who will perform work on the public work project on my
behalf will be properly classified as an employee or as an independent contractor
under all applicable state and federal laws and local ordinances.
(vi) _
For every project, submit evidence of participation in apprenticeship and training
programs, applicable to the work to be performed on the project, which are
approved by and registered with the United States Department of Labor's Office of
Apprenticeship, or its successor organization.
(vii) _
Copy of a written plan for employee drug testing that covers all of my employees
who will perform work on the public work project and meets or exceeds the
requirements set forth in IC 4-13-18-5 or IC 4-13-18-6.
(viii) _
Evidence that I am utilizing a surety company which is on the Bureau of Fiscal
Service "Department of Treasury's Listing of Approved Sureties" as required in the
bid specifications or contract.
Version 01/13/2021 General Conditions - 8
(ix) _ Written statement of any federal, state or local tax liens or tax delinquencies owed
to any federal, state or local taxing body in the preceding three years.
(i) _ List of projects of similar size and scope of work performed in all areas, including
the State of Indiana, within three (3) years prior to the date on which the bid is due.
Date: 4/1 (220;/ /Z
ov a c to, V.*
t' •���t4 0 Rg TF ��
rint Name Here)
Milestone Contractors North. Inc.
(Name of Company)
24358 SIR 23
(Address of Company)
South Bend
(City)
Indiana
(State)
574-288-4811
(Telephone Number)
Version 01/13/2021 General Conditions - 9
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: April 13 2021
Part of State Form52414 (R2 / 2-13) Form 96 (Revised 2013)
-.111XG]�
Milestone Contractors North, Inc.
(Contractor)
24358 SR_2Z3
(Address)
South Bend, IN 46614
FOR
PUBLIC WORKS PROJECTS
OF
City of South Bend, Indiana
2021 Asphalt Material Bid
Proiect No. 121-026
Filed April 13th, 2021
Action taken
State Form 52414 (R J 9-10)
Prescribed by State Board of Accounts _ Form No. 96 (Revised 2013)
CONTRACTOR'S BID FOR PUBLIC WORK — FORM 96
PART 1
(To be completed for all bids. Please type or print)
Date (month, day, year): April 13th, 2021
1. Governmental Unit (Owner): City of South Bend, Indiana
2. County: St. Joseph
3. Bidder (Firm):
Address:
City/State:
4. Telephone Number:
5. Agent of Bidder (If applicable):
Milestone Contractors North, Inc.
24358 SR 23
South Bend, IN 46614
(574) 288-4811
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the public
works project of City of South Bend, Indiana (Governmental Unit) in accordance with plans and specifications
prepared by Department of Public Works — City of South Bend and dated March 19th & 26t , 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.
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 13.2021
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
What public works projects has your organization completed for the period of one (1) year prior to the date of
the current bid?
Contract Amount
Class of Work
When Completed
Name and Address of Owner
$ 12,170,428
Reconstruction
Resurface
May 2019
November 2019
Walsh Construction
Lake CopHwy Dept
$ 5,489,454
$ 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 Mu h
Gough Inc. 2200 E. 88' Dr., Merrillville IN 46410 Mr. Raymond Gough _
Dver Construction Co. 1716 Sheffield Avenue Der IN Janet Furman
Grimmer Construction Co Inc. 2619 Main Street Highland, IN Mr. Greg Grimmer
SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE
1. Explain your plan or layout for performing proposed work. (Examples could include a narrative of when you could
begin work, completed the project, number of workers, etc. and any other information which you believe would
enable the governmental unit consider your bid.)
As required by owner
2. Please list the names and addresses of all subcontractors (i.e. persons or firms outside your own firm who have
performed part of the work) that you have used on public works projects during the past five (5) years along with a
brief description of the work done by each subcontractor.
See Attached List
3. If you intend to sublet any portion of the work, state the name and address of each subcontractor, equipment to be
used by the subcontractor, and whether you will require a bond. However, if you are unable to currently provide a
listing, please understand a listing must be provided prior to contract approval. Until the completion of the proposed
project, you are under a continuing obligation to immediately notify the governmental unit in the event that you
subsequently determine that you will use a subcontractor on the proposed project.
Will supply upon award of contract
QUANTITY
ITEM
DESCRIPTION,
SIZE, CAPACITY,
ETC.
CONDITION
YEARS
OF
SERVICE
PRESENT LOCATION
5
Asphalt Plants
Various
Good
Griffith, South Bend,
Valparaiso, Lowell, LaPorte
19
Asphalt Pavers
Various
Good
Griffith, South Bend
4
Sli form Conc. Paver
Various
Good
Griffith, South Bend
3
Road Widener
Various
Good
Griffith, South Bend
5
Motor Graders
CAT/J.D.
Good
Griffith, South Bend
56
Rollers
Various
Good
Griffith, South Bend
36
Rubber Tire Loaders
Various
Good
Griffith, South Bend
18
Excavators
Various
Good
Griffith, South Bend
9
Bulldozers
Various
Good
Griffith, South Bend
7
LowBoy Tractors
Various
Good
Griffith, South Bend
9
Flatbed Dumps
Various
Good
Griffith, South Bend
54
%2 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
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 swom 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
V11111111/AI�'
aCtors �rorf�
"
ACKN
STATE OF Indiana 1
)SS
COUNTY OF St. Joseph _
of Organization)
y, VP of South Bend Area
(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 13`h day of April,. 2021.
Alisha Krueger, Notary lic
ALISHA KRUEGER
;0,. ••a�'; Notary Public, State of India
=z:SEAL;"= St. Joseph County
�� �•....• My Commission Expires
June 05, 2022
My Commission Expires: June 5, 2022
County of Residence: St. Joseph
Form 96 Section II, #2
Subcontractors Used on Public Works Contracts During
SUBCONTRACTORS
COMPANY ADDRESS CITY/STATE/ZIP
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 Company
ELECTRICAL INSTALLATION
Hawk Enterprises
Midwestern Electric
S/T Bancroft Electric
Sweney Electric Company
Trans Tech Electric
SIGN INSTALLATION
Hawk Enterprises
Midwestern Electric
RoadSafe Traffic Systems
State Barricading, Inc.
Traffic Control Specialists, Inc.
PAVEMENT MARKINGS
The Airmarking Company
Blackout Sealcoating
RoadSafe Traffic Systems
State Barricading, Inc.
Traffic Control Specialists, Inc.
Traffic Management Company
TRAFFIC CONTROL
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
the Past 5 Years
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
Michiaan Citv. IN 46361
PHONE I FAX
(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
(219)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 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
RoadSafe Traffic Systems 3122 Olympia Dr Lafayette, IN 47909
Traffic Control Specialists, Inc. 1810 W Pacific Avenue Knox, IN 46534
Traffic Management Company 3542 Highway Avenue Highland, IN 46322
LANDSCAPE
Great American Landscape
Hubinger Landscape
Slusser's Green Thumb, Inc.
P.O. Box 235
210 E. 113th Avenue
125 Montgomery Street
6
Dyer, IN 46311
Crown Point, IN 46307
Logansport, IN 46947
(219) 662-8090
(219) 397-4444
(574) 287-6490
(219) 769-6007
(574) 272-9673
(219) 662-8090
(219) 397-4444
(317) 780-1825
(574) 287-2078
(574)772-7001
(574) 223-5817
(219) 864-2300
(317) 780-1825
(574) 287-2078
(574)772-7001
(291) 746-2433
(317) 780-1825
(574)772-7001
(219) 746-2433
(219) 662-8093
(219) 397-8888
(219) 769-0565
(574)271-0144
(219) 662-8093
(219) 397-8888
(574)772-7002
(574)223-7959
(708)430-6910
(574)772-7002
(574)772-7002
(219) 322-7033 (219) 322-4419
(219) 662-9911 (219) 662-6206
(574) 722-3102 (574) 722-1628
T & J Landscape Service
GUARDRAIL/FENCING
8253 Wicker Avenue
Acorn Fence
2041 164th Street
C Tech Corporation
5300 W. 100 North
James H. Drew Company
8701 Zionsville Rd.
Security Industries
1000 Georgiana St.
Specialties Company
9350 E. 30th St.
TRUCKING/HAULING
_
C. Lee Construction Services
1011 S. Lake St
Condon Trucking, LLC
18245 Amberley Ln
Fanio Services
28015 SR 23
St. John, IN 46373
374-9900 (219) 374-9950
Hammond, IN 46320
(219) 844-8400
(219) 844-8441
Boggstown, IN 46110
(317) 835-2745
(317) 835-2781
Indianapolis, IN 46268
(317) 876-3739
(317) 876-3829
Hobart, IN 46342
(219) 942-9447
(219) 942-9448
Indianapolis, IN 46229
(317) 594-0291
(317) 594-0271
(219) 888-9564
Gary, IN 46403
(219) 888-9554
South Bend, IN 46637
(574) 360-4326
(574) 271-8984
North Liberty, IN 46554
(574) 233-3236
Gilmer Trucking
20390 New Road
6outn tsena, IN 40014
(b/4) 229-3Z33
Material Transfer Inc.
7811 West 101st Ave.
Crown Point, IN 46307
(219) 865-9575
Morris Motor Service, Inc.
10525 W US Hwy 30 Bid
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
Financial Statement for Bidders
Prescribed by
THE STATE BOARD OF ACCOUNTS OF INDIANA
For use in investigating and determining the qualifications of bidders on public
construction when the aggregate cost of any such work or improvement will be Five Thousand
Dollars or more.
These statements to be submitted under oath by each bidder with and as a part of his bid, as provided
by Chapter 306, page 1248, Acts of 1947
Submitted to City of South Bend Indiana
By Milestone Contractors North, Inc.
fA Corporation
Address 1700 E. Main St, Griffith, IN 46319
Date submitted Avril 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. (Bums Statutes 1933, Sec. 53-109) Sec. 2, Chapter 306,
Acts of 1947.
2
TO THE BIDDER —
The following forms of questionnaires and financial statement are prescribed by the State Board of
Accounts in conformity with the statute set out on the preceding page.
These forms, properly filled out and attested, must accompany each bid of five thousand dollars or
more on any public work.
The forms are designed to cover all contracts for all kinds of work and the bidder is required to answer
such questions as are pertinent to the work upon which he is bidding. The purpose of the questionnaire and
financial statement, as set forth in the law, is to enable the awarding body to determine the qualifications
of the bidder to carry out successfully the contract if the same is awarded to him.
The bidder will find it to his advantage to answer fully all questions coming within the range of the
work upon which he is bidding. Particular attention should be given the "Financial Statement" and the
details relative to the assets and liabilities set out. This form is made in extensive detail so that the bidder
may explain his assets and liabilities in proper sequence and in a uniform manner.
T. M. HINDMAN,
State Examiner
The name of the partnership firm under which the above partners are operating is
COUNTY OF
Give names and titles of all persons having authority to execute and receipt estimate vouchers and to conduct
other business for the partnership, the signatures of whom are legally binding.
The undersigned hereby declares that the foregoing is a true statement of the financial condition of the individual, co -partnership
or corporation herein first named, as of the date herein first given; that this statement is for the ex s pu . ose of inducing the party to
whom it is submitted to award the submittor a contract; and that any depository, vendor or o ncy ein named is hereby authorized
to supply such party with any information necessary to verify this statement.
NOTE: A co -partnership must give fmn name and signatures of all
partners. A corporation must give full corporate name, signature of official
and affix corporate seal.
�111111/ i
Lontract
...... ors
Affidavit for Individual o `ORp 0 RA;,-,' s G
STATE OF = n:
COUNTY OF ss: SEAL.-'.')
being duly sworn, dep�s and.�says.tltarthe
foregoing financial statement, taken from his books, is a true and accurate statement of his financial condition as o4*1 \qWu
that the answers to the foregoing interrogatories are true. ��111111110
(Applicant must sign here)
Subscribed and sworn to before me this
,day of 20.
Notary Public
Affidavit for Co -Partnership
STATE OF
{ ss
being duly sworn, deposes and says that he is a
member of the firm of ; that he is familiar with the books of the said
firm showing its financial condition; that the foregoing financial statement, taken from the books of the said firm , is a true and accurate
statement of the financial condition of the said firm as of the date thereof and that the answers to the foregoing interrogatories are true.
(Member of firm must sign here)
Subscribed and sworn to before me this
_day of 20.
Notary Public
Affidavit for Corporation
STATE OF Indiana
{ COUNTY OF St. Joseph ss
Dustin Hilary being duly sworn, deposes and says that he is VP of South I
the corporation described in and which executed the foregoing statement; that
showing its financial condition; that the foregoing financial statement, taken
statement of the financial condition of said corporation as of the date thereof r
Subscribed and sworn to before me this
13a' dan,of
, Notary Public
ALISHA KRUEGEF;
,0IWO1I11"o,
O�Pa^pGe�'% Notary Public, stele of ImJi•2n11gg'
EA
St. St. Joseph County t,
' *
• rh'DIP�P��
My Commission Expn'es M
June 05, 2022
,;x<-o he Milestone Contractors North. Inc.
'am' ar with the books of the said corporation
oks of the said corporation, is a true and accurate
the answe the foregoing interrogatories are true.
ice must sign here) Dustin Hilary, VP of South Bend Area
ont r1a cto`����i
(ORPOR4 s
15
/1111111110
CITY OF SOUTH BEND JAMES MUELLER, MAYOR
DEPARTMENT OF PUBLIC WORKS
ERIC HORVATH, DIRECTOR
September 23, 2020
Mr. Dustin Hilary
Walsh & Kelly, Inc.
dhilarvrq'walshkelly .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,
Dw "' Bey HE"'
Liz Horvath mow.
O�tc MNA93] 11529� d{W
Liz Horvath, Permit Manager
1/10/2016 2:42 PA FROM: MOEITS TO: •12189248768 P. 8
' •� INTERNATIONAL UNION OF OpEIL1TmG1 I4'NODVEm26
�I GZp n�� ��C[C�__ - - .- - .� ue•r cues we.�p �b�•e��rx. nnr.fue. was. ner - _.
JAMES M. ZWEMEY •waw.a....,.<...,. •w•w�••••w• .�.u.m. wiwsmnw
C rmmrar�s � - - mrnn•cii®aMa
Imusry 10, 2019
m q Welsh & Kelly
3l r 1700E.N SI.
Gdffid4 Rat 46319
Ae: ProofaFCompliutoe with 301I1S 50090 73(6)
Our Fik No.Ml4M21
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
o ` r m ,C • (N.11.012020003 end IL001780173).
Aa a slpmmry mmmelor w1A Ote lmamtonni Union of
��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
�1!n (p ��••••�� �dri/ rWsWW with thcUuited SMa Depo4npt ofLAWs B® mu ofAppmtiewhip and
-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.
O �Dr7
vim[ Very WlY Yours,
q' CIA , . � � IU08, laed ISa AFL•CIO
V. N District I dlepslcb ottiee
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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
MILLSTONE CONTRACTORS NORTH, INC.
duly filed the ,requisite documents to commence ,business activities under the laws.°of the State of
Indiana on March 29, 1966, and was in existence or authorized to transact business in the State of
Indiana on March 16, 2021.
I further certify this Domestic For -Profit Corporation has filed its most recent report required by
Indiana law with the Secretary of State, or is not yet required to.file such report, and that no notice of
withdrawal, dissolution, or expiration has been filed or taken "place. All fees, taxes, interest, and
penalties owed to Indiana by the domestic or foreign entity and collected by the Secretary of State
have been paid.
In Witness Whereof, I have caused to be affixed my
signature and the seal of the State of Indiana, at the City
of Indianapolis, March 16, 2021
Cam, 7j�......
CONNIE LAWSON
SECRETARY OF STATE
194484-057 / 20211917617
All certificates should be validated here: https://bsd.scs.in.gov/ValidateCertificate
Expires on April 15, 2021.
State of Indiana
Office of the Secretary of State
Certificate of Amendment
of
WALSH & KELLY INC
I, CONNIE LAWSON, Secretary of State, hereby certify that Articles of Amendment of the above
Domestic For -Profit Corporation have been presented to me at my office, accompanied by the fees
prescribed by law and that the documentation presented conforms to law as prescribed by the
provisions of the Indiana Code.
The name following Old 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
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 been'O s2nted to me at my office, accompanied by the fees
prescribed by law and that the documentation presented conforms,tdlaw as prescribed by the provisions
of the Indiana Code.
Following said transaction, the above named'entity will.transact business under t"ssumed business
name(s) of:
WALSH,- KELLY
NOW, THEREFORE, with this document I certify that _said transaction will become effective Monday,
February 01, 2021. ?w
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.
erL44.�� a%- 4w"*�.
CONNIE LAWSON
SECRETARY OF STATE
194484-057 / 8878234
To ensure the certificate's validity, go to https://bsd.sos.in.gov/PublicSusinessSearch
Form —9I
(Rev. October 2018)
Department of the Treasury
Internal Revenue Service
Request for Taxpayer
Identification Number and Certification
► Go to www.irs.gov/FormWQ for instructions and the latest information.
i Name tas shown on your income tax return). Name is required on tins line; do not leave this tine
MILESTONE CONTRACTORS NORTH, INC.
z esusiness nomeroisregaroeo entity name, n anrerenrtrom above
WALSH & KELLY, INC.
aMi 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the
5P following seven boxes.
C
0
a;c
0
02
t W
T c
a D
0
m
a
f/1
m
❑ Individuallsole proprietor or ❑ C Corporation ID S Corporation ❑ Partnership ❑ Trustlestate
single -member LLC
Give Form to the
requester. Do not
send to the IRS.
4 Exemptions (codes apply only to
certain entities, not individuals; see
Instructions on page 3);
Exempt payee code (d 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. Do 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.
Other (see instructions) 0-
5, Ad raw (number, street, and apt. or
1700 EAST MAIN STREET
a City, state, and LIP code
3RIFFITH, IN 46319
r ust account numberts) here (optional)
(AupL'w toawowft wmktaned outside the us1
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 security number (55N). However, for a - m -�
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
77N, later. or
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Employer identification number
Number To Give the Requesterfor guidelines on whose number to enter, i
3T 5 1 - F1 F1 72 0 b l 87 5 1
,0 Certification _ _
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2.1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that i am
no longer subject to backup withholding; and
3. 1 am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (f 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 comsat TIN. See the instructions for Part II, later.
Sign ^ signature of
Here U.s. person► �JA (-
General Instructions
br &-v roohz I Date► 2-1 t q 12 j
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 wwwJrs.gov1FormW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (AMN), 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-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan interest),
1098-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
if you do -not retum 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 rules of this Board, hereby issues a
Certificate of Qualification to provide construction services to the State of Indiana for Public Works Projects to:
WALSH - KELLY INC
1700 E MAIN ST
GRIFFITH IN 46319
Phone 219-924-5900
Fax 219-924-8768
Company Official
JOHN PEISKER
for the twenty-seven month period stated herein, unless revoked by this Board for cause,
and in the classifications of services stated below. This certificate supercedes any previous certificate.
1611.01 Concrete Construction of Roads & Curbing
1611.02 Asphalt Construction of Roads and Parking Lots
CERTIFICATION DATE 11/4/2020
EXPIRATION DATE 2/4/2023
THIS CERTIFICATE ISSUED BY THE STATE OF INDIANA, PUBLIC WORKS DIVISION CERTIFICATION BOARD,
402 WEST WASHINGTON STREET, ROOM W467, INDIANAPOLIS, INDIANA 46204,
ALSO ACTS AS THE OFFICIAL NOTICE OF EXPIRATION.
—SK1 �f. C�
Tracy L. Cross, EX tive Secretary
Certification Board
DAPW PQ2 State Form 3983R Rev. 07/06
WRITTEN CONSENT TO RESOLUTIONS
of the
BOARD OF DIRECTORS
of
WALSH & KELLY, INC.
The undersigned, being all of the Directors of WALSH & KELLY, INC., an Indiana Corporation,
hereby consent to the following actions to be taken by the Corporation without a meeting of the Board of
Directors under the applicable provisions of the Indiana Business Corporation Law, as amended:
RESOLVED that the following be, and hereby are, elected officers of the Corporation, to
hold the office until the next regular meeting of the Board of Directors and until their
successors are duly elected and have qualified: .
John M. Peisker, President
Jeffrey L. Swan, Executive Vice President
John P. Vercruysse, Executive Vice President
Jamie L. Tancos, Vice President of Finance, Secretary & Treasurer
Gregory A. Kelly, Vice President
Charles Potts Jr., Vice President
Albert E.VanDenBergh, Vice President
David L. Franz, Vice President
David J. Misirly, Vice President
Gregory A. Hoffman, Vice President
Dustin P. Hilary, Vice President
Lynn J. Bauer, Vice President
Mark E. Krachenfels, Vice President
RESOLVED FURTHER that the actions of the Officers of the Corporation taken since the
last meeting of the Board of Directors be, and the same hereby are, fully ratified and
approved.
RESOLVED FURTHER that the following be, and they hereby are, authorized to execute
all contracts or similar documents on behalf of the Corporation:
John M. Peisker, President
Jeffrey L. Swan, Executive Vice President
John P. Vercruysse, Executive Vice President
Jamie L. Tancos, Vice President of Finance, Secretary & Treasurer
Gregory A. Kelly, Vice President
Charles Potts Jr., Vice President
Albert E.VanDenBergh, Vice President
David L. Franz, Vice President
David J. Misirly, Vice President
Gregory A. Hoffman, Vice President
Dustin P. Hilary, Vice President
Lynn J. Bauer, Vice President
Mark E. Krachenfels, Vice President
RESOLVED FURTHER that this consent shall be in lieu of an annual meeting of the Board
of Directors of the Corporation and shall be filed in the minute book of the Corporation in
place of any such annual minutes.
<<SIGNATURES ON THE NEXT PAGE>>
EXECUTED this 15'h day of January, 2020.
Fred Feh.-e feld, Jr. ,
Albert E. VanDenBergh
Kevin J. Kelly
James VFebsenfeld
J �PVcrcruysse
EXECUTED this 15'h day of January, 2020.
Fred Fehsenfeld, Jr. James C. Fehsenfeld
Albert E. VanDenBergh
Kevin J. Kelly
John P. Vercruysse
EXECUTED this 15'h day of January, 2020.
Fred Fehsenfeld, Jr.
Albert E. VanDenBergh
l
IL - d i��
Kevin J. Kelly
James C. Fehsenfeld
John P. Vercruysse
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.
C) POWs, Chief Operating Officer
Margaret Garner, HR Area Partner/EEO Officer
February 2021
EOE AVFNets/Disabled
P,i,milestone
DATE: February 26, 2021
TO: All Employees
RE: EEO Officer Appointment
Margaret Garner has been appointed Equal Employment Opportunity Officer for Milestone
Contractors. It is her responsibility to coordinate, advise and assist management and
supervisors in their responsibilities of assuring all applicants and employees' equal
opportunities in all aspects of their employment. She will review complaints that allege
discrimination because of race, religion, color, sex, sexual orientation, gender identity, age,
national origin, disability, housing status or veteran status.
Employees of Milestone Contractors are to submit any issues or concerns to Margaret. We are
committed to comply with the provisions of the Civil Rights Act of 1964 and 1991, plus all
Executive Orders issued relating to Equal Employment.
Margaret's contact information is listed below.
Milestone Contractors
7661 N Perimeter Rd, Suite 200
Indianapolis, IN 46241
mgarner@milestonelp.com
(317)616-4937
CJ P 5ts, Chief Operating Officer
EOE M/FNets/Disabled
(a iftratr Jorf (Qua ttinratiou
• r
ISSUED BY
MI 07.11111
J : 1 1 J 1
INDIANAPOLIS, IN
TO
WALSH & KELLY INC
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
� k-�
PREQ[IALIFICATION ENGINEER
State Form 20508 IR3 1 5.051
COMMISSIONER
PREQUALIFICATION WORKSHEET
ACCT : # 35-1120685 ALT ACCT: # 0449 NEW? SUPP?
NAME: WALSH & KELLY INC
December 31, 2019 CURRENT FIXED EQUIPMENT
ASSETS REPORTED $47,119,378.00 $10,219,627.00 $31,032,017.00
LIABILITIES REPORTED ($16,158,151.00) ($16,742,213.00)
NET ASSETS REPORTED $30,961,227.00 ($6,522,586.00) $31,032,017.00
09 OMIT NO DETAIL OR QUANTITY
11 OMIT NO DETAIL
15 CASH SURRENDER VALUE
16 OMIT INTANGIBLES
22 DUE AFTER 24 MONTHS
NET FIXED ASSETS
NET FIXED ASSETS EQUIPMENT
NET ACCEPTABLE ASSETS
RATING FACTORS
RATING COMPONENTS
($4,016,185.00)
$0.00
$0.00
($277,917.00)
$0.00
$0.00
$1,390,248.00
($1,390,248.00)
$0.00
$0.00
($864,210.00)
$0.00
$0.00
$13,536,060.00
$0.00
$0
$0
$28,057,373 $4,759,016
X 10 X 2
$280,573,730 $9,518,032
X 1.5 -
MAXIMUM EQUIPMENT $420,860,595
$248,256,136
+ $280,573,730
$528,829,866
X 0.25
MAXIMUM FIXED $132,207,467 ADJ. FIXED
CURRENT ASSETS:
--------------------------- ---
INVENTORY:
--------------------------------
CURRENT LIABILITIES:
--------------------------------
LONG TERM LIABILITIES:
--------------------------------
NET WORTH:
TOTAL LIABILITIES:
NOTES:
BALANCE SHEET ANALYSIS
$47,119,378
----------------- ------- -
CURRENT RATIO:
$4,016,185
QUICKRATIO:
$16,158,151
------ -----------------
WORKING CAPITAL:
$16,742,213
----- - -------------------
DEBT/NET WORTH:
$55,470,656
$32,900,364
$31,032,017
X 8
$248,256,136
$248,256,136
-----------------
$0
8.00
$0
$4,759,016
-
----------------
$4,759,016
X 2
$9,518,032
-
------------- ---
2.916
2.668
$30,961,227
--------------
0.593
PRINTED: 5/21 /2020
PQA APPROVED: 5/7/2020
APPROVED BY: �m —A—j
DATE: 5/21/2020
VALID:
EXPIRES:
DENIAL DATE:
DENIAL REASON:
COMPONENT
CURRENT
FIXED
EQUIPMENT
----------------------------
MAXIMUM BALANCE
STATEMENT TYPE:
EXPER. REDUCTION
AGGREGATE
C(B)
B(A)
E(F)
E(E)
E(R)
A(B)
E(Q)
E(H)
E(G)
5/21/2020
4/30/2021
RATING
$280,573,730.00
$9,518,032.00
$248,256,136.00
------------------------
$538,347,898.00
AUDITED
0%
UNLIMITED
UNLIMITED
UNLIMITED
$50,000,000
$25,000,000
$50,000,000
$25,000,000
$25,000,000
$25,000,000
$25,000,000
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date Apri17, 2021
Department Public
Name Scott
BPW Date April 13, 2021 Phone Extension 9245
Required Prior to Submittal to Board
BPW Attorney ® Attorney Name Clara McDaniels
Dept. Attorney ❑ Attorney Name
Purchasing ❑ Michael Schmidt
Check the Appropriate Item Type — Required. for All Submissions
❑ Professional Services Agreement ❑ Contract ❑ Proposal
❑ Open Market Contract ❑ Amendment/Addendum ❑ Special Purchase, QPA
® Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet
❑ Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes
❑ Proposal Opening ❑ C/O & PCA No. ❑ PCA
❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution
❑ Other: ❑ Ease./Encroach
Company or Vendor Name
New Vendor
MBE/WBE Contractor
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description
Information
❑ Yes ❑ If Yes, Approved by Purchasing
❑ No
E] MBE
❑ WBE Completed E-Verify Form Attached ❑❑ Nos
2021 Asphalt Materials Bid
121-026
MVH R, LRS Major Moves
266-06-602-503-423002, 251-06-600-506-423002, 412-06-600-506-
423002
For Change Orders Only
Amount of ❑ Increase $
❑ Decrease ($ )
Previous Amount
Current Percent of Change
New Amount
Increase
Decrease
Increase
Total Percent of Change: Decrease
Time Extension Amount:
New Completion Date: