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Home My WebLink AboutOpening of Bids - 2021 Contractor Paving Round 1 Proj No. 121-016 - Milestone Contractors North, Inc.CITY OF SOUTH BEND, INDIANA5' CONTRACTOR'S BID FOR PUBLIC WORK CHECKLIST FOR BIDDERS Project Name 2021 Contractor Paving Round 1 Project No. 121-016 For Bids Due 9:00 a.m., April 13, 2021, 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 and comply with the specifications. Bidder: Milestor By Authorized Rep Signature: Print Name & Title: Version 01/13/2021 Contractor's Bid for Public Works - 1 Date: 4/13/2021 %Ju i i r 111.,J C.o�tra ctors ?' o: `pFPORgTF :;sG ;�': SEAL.'' CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK Project Name 2021 Contractor Paving Round 1 Project No. 121-016 For Bids Due 9:00 a.m., April 13, 2021, Local Time Date: Address: City/State/Zip: PART I (Must be completed for all bids. Please type or print) 4/13/2021 Bidder (Firm): Milestone Contractors North, Inc. 24358 SR 23 South Bend, IN 46614 Telephone Number: 5�74 _) 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 - 2021 Contractor Paving Round 1 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 12, 2021 for the sum of (enter the Total Bid as shown on the Proposal) One million one hundred thirtV eight thousand dollars and zero cents i$ 1,138,000.00 (Enter sum of all Divisions 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 specifically referenced at the applicable page. If additional units of material included in the contract are n , the cost of units must be the same as that shown in the original contract if accepted by the City h,leend. If the bid is to be awarded on a unit basis, the itemization of the units shall be shown ongspoarob attachmeg1 By The above bid is accepted this Subject to the following conditions: BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Gary A. Gilot, Member Dustin Hilary, VP of South Bend Area (Printed Name of Person Signing) ACCEPTANCE day of 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. 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 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 2, 2021 All Planholders Anne Fuchs, Clerk, Board of Public Works Addendum Number: 1 2021 Contractor Paving Round 1 _ 121-016 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: 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 Cont rs Authorized Signature: tin Hilary, Date: 4/2/2021 rth, Inc. At uuu�� toto r�� I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for public works are true and correct. Dated this 13th day of April , 2021 %,`%.tIIIIIff'r O`ortracto i�%.. SEAL .:.n Subscribed and swornto before me this 13th My Commission Expires 6/5/22 County of Residence WOOME it , of Contractor/Bidder or Its Agent ' Dustin Hilary,_VP of South Bend Area Printed Name and Title day of Aril , 20 21 4-�J� &-U -f No 'tai7 Public Ali a rueger St. Joseph ALISHA KRUEGER o; Notary Public, State of Indiana ;SEAL."= St. Joseph County My Commission Expires 11A 11AN June 05, 2022 Version 01/13/2021 Contractor's Bid for Public Works - 6 BID/PROPOSAL CITY OF SOUTH BEND PROJECT NAME: 2021 Contractor Paying Round 1 PROJECT NO. 121-016 FOR BIDS DUE: April 13, 2021 @ 9:00 a.m. Local Time,, "- CONTRACTOR NAME: Milestone Contractors North, Inc. ties Item No. DIVISION 1 Line Item Quantity Maintenance of Traffic 1 Mobilization and Demobilization 1 Unit Cost Unit Price 1 LS 34,719.50 $34,719.50 2 LS SY 24,300.00 4.20 $24,300.00 $90,426.00 3 Milling, 3" 21530 4 HMA Surface, 9.5 mm — Type B 3545 355 TONS TONS 72.00 69.00 $255,240.00 $24,495.00 $13,950.00 $120.00 5 HMA Wedge and Leveling —Type B HMA for Patching 6 93 12 TONS TONS 150.00 10.00 7 Tack Coat 8 Joint Adhesive, Surface 7923 LF 4.00 $31,692.00 9 Adjust Manhole to Grade 27 EA 200.00 $5,400.00 10 Adjust Water Valve Structure to Grade 3 EA 100.00 $300.00 11 Adjust Inlet to Grade 14 EA 275.00 $3,850.00 12 Line, Thermoplastic, Solid, White, 6" 130 LF 6.75 $877.50 45.00 $630.00 $486,000.00 13 Transverse Marking, Thermoplastic, Solid, White, 24" 14 LF DIVISION 1 TOTAL Version 01/13/2021 Contractor's Bid for Public Works - 7 PROJECT NAME: PROJECT NO. FOR BIDS DUE: CONTRACTOR NAME: BID/PROPOSAL CITY OF SOUTH BEND 2021 Contractor Paving Round 1 121-016 April 13, 2021 @ 9:00 a.m. Local Time Milestone Contractors North. Inc. Line Item Maintenance of Traffic DIVISION 2 Item No. Quantity Unit Unit Price Cost 1 1 1 LS LS 24,738.90 30,000.00 $24,738.90 $30,000.00 $3,025.00 2 Mobilization and Demobilization Milling, 1.5" 3 550 SY 5.50 4 Milling, 3" HMA Surface, 9.5 mm —Type B 28940 SY 3.90 $112,866.00 5 5324 TONS 69.00 $367,356.00 6 HMA Wedge and Leveling — Type B HMA for Patching 533 TONS 64.00 $34,112.00 $23,400.00 7 156 TONS 150.00 8 Tack Coat 10 TONS 10.00 $100.00 9 Joint Adhesive, Surface 11128 LF 4.00 $44,512.00 10 Adjust Manhole to Grade 20 2 4 EA EA 200.00 100.00 $4,000.00 $200.00 11 Adjust Water Valve Structure to Grade 12 Pavement Message Markings, Thermoplastic, White, Lane Indication Arrow EA 165.00 $660.00 13 Pavement Message Markings, Thermoplastic, White, "Only" 1 EA 225.00 $225.00 14 Line, Thermoplastic, Solid, White, 4" 420 LF 0.79 $331.80 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> 2021 Contractor Paving Round 1 121-016 April 13, 2021 @ 9:00 a.m. Local Time Milestone Contractors North. Inc. DIVISION 2 CONTINUED Item No. Line Item Quantity Unit Unit Price Cost Line, Thermoplastic, Solid, White, 15 6„ 128 LF 2.25 $288.00 Line, Thermoplastic, Solid, Yellow, 4" 16 2170 LF 0.79 $1,714.30 Line, Thermoplastic, Broken, Yellow, 4" 17 1380 LF 0.79 $1,090.20 Grooving for Pavement Markings, 4" 18 3970 LF 0.64 $2,540.80 Transverse Marking, Thermoplastic, Solid, 19 White, 24" 56 LF 15.00 $840.00 DIVISION 2 TOTAL $652,000.00 DIVISIONS 1 AND 2 TOTAL: The Contractor must bid on all Divisions to be eligible for award. Bidder(Firm): Address: City/State/Zip Telephone Number: Fax Number: rw a c to s��° y•. `o�y RArr AL .1 n /11111 Milestone Contractors North, Inc. 24358 SR 23 South Bend,IN 46614 574-288-4811 574-289-7174 $1,138,000.00 (signature) Dustin Hilary, V.P. of South Bend Area Version 01/13/2021 Contractor's Bid for Public Works - 9 (Printed Name of Person Signing) f. F CITY OF SOUTH BEND ' MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MWBE-1.0 d; MWBE UTILIZATION PLAN This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MBE participation. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the MBE qualifications. Project Number: Bidder 121-016 Project Name: 2021 Contractor Paving Round 1 Milestone Contractors North. Inc. Total Bid Amount: $1,138,000.00 Name & Address of MBE C. Lee Construction Services, Inc. 1011 S. Lake Street Gary, IN 46403 Primary Contact Person (Name/Telephone) Frederick "Chip" Lee 219-888-9554 Submitted by: Dustin_ Hilary _ Print Name Scope of Work to be Performed (Attach scope/schedule if you need additional space) Hauling Version 01/13/2021 Contractor's Bid for Public Works - 10 MBE Goal: 4.2% Page 1 of Dollar Amount of MBE Percentage Component of Total $47,800.00 1 4.2% 4/13/2021 Date ��'urH b�ti CITY OF SOUTH BEND �,^ MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN ��'• rbwci 14- Ij FORM MWBE-1.0 MWBE UTILIZATION PLAN 4 !`� 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: 121-016 Project Name: 2021 Contractor Paving Round 1 Bidder: Milestone Contractors North, Inc. Total Bid Amount: $1,138 000.00 WBE Goal: 6.0% Page 1 of 1 T Primary Contact Person Name & Address of WBE Scope of Work to be Performed Dollar Amount of WBE Percentage of Total - (Name/Telephone) (Attach scope/schedule if you need additional space) _ Component Bid/Proposal Traffic Control Specialists, Inc. Barry Triska 1810 W. Pacific Avenue 574-772-7001 Pavement Markings $12,193.00 1.07% Knox, IN 46534 State Barricading, Inc. 24963 US 20 James Michalski Traffic Control Devices $4,250.00 574-287-2078 0.37% South Bend, IN 46628 V & R Trucking, Inc. 1845 N. Elmer Veda Godette Hauling $52,400.00 4.6% South Bend, IN 46628 574-234-1268 L Submitted by: Dustin Hilary Print Name Version 01/13/2021 Contractor's Bid for Public Works - 11 4/13/2021 Date CITY OF SOUTH BEND s MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN P PCEry 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: Project Name: Bidder: Contact Person: Address: City: 121-016 2021 Contractor Pavinq Round 1 Milestone Contractors North, Inc. Edward Pilipow 24358 SR 23 South Bend State: Indiana Date: 4/13/2021 Telephone: 574-288-4811 zip: 46614 Email: epilipow(d),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(S): The bidder reviewed 1) the City of South Bend's Minority and Women Business Enterprise Inclusion Program Plan; 2) the list of certified MWBEs provided by the City; and 3) the Indiana Department of Administration list of Minority and Women Owned Businesses (both certified and non - certified) found at: hftr)://www.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 thttp://www.in.gov/idoa). 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 n / bonding, lines of credit, or insurance as required by the City or the bidder, where W�L appropriate. Version 01/13/2021 Contractor's Bid for Public Works - 12 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN PXE: i y q.. FORM MWBE-2.0 ' EVIDENCE OF GOOD FAITH EFFORTS I affirm that I have made good faith efforts to assist interested MWBEs in obtaining D 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 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: Bidder:;�,�-/ By:� 1 Contractor Paving Round 1 setone Contractors North, Inc. Dustin Hilary VP of South Bend Area (Title) WE Firm C. Lee Construction Services, Inc. Owner or Contact at MBE Firm Frederick "Chip" Lee Telephone: 219-888-9554 Fax: 219-888-9564 TYPE OF WORK SOLICITED FOR THIS PROJECT: Haulina - Materials Email: chip@cleecsi.com RESULTS OF CONTACT WITH THE MBE FIRM: We'll lease C. Lee Construction Services, Inc. for hauling if we are awarded the project. (Date) MBE Firm Highway. Safetv Services. Inc. Owner or Contact at MBE Firm Doug Nagel Telephone: 765-474-1000 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 progect is too far away and the scope of work is too small. Version 01/13/2021 Contractor's Bid for Public Works - 14 TH CITY OF SOUTH BENDIt ' ,. MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN mwv 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: 121-016 MBE Participation Goal 4.2% Project Name: Bidder: By: _ ... _��► Pavinr, Round 1 ksetone Contractors North; Inc. -� VP of South Bend Area 4/13/2021 Dustin Hilary (Title) (Date) 1°'V r""' Victory Trucking, Inc. dba Three Rivers Barricade Owner or Contact at MBE Firm Eldon Byler Telephone: 260-436-1611 Fax: Email: eldonb@3riversbarricade.net TYPE OF WORK SOLICITED FOR THIS PROJECT Traffic Control - MOT & Pavement Markinos RESULTS OF CONTACT WITH THE MBE FIRM: They did not submit quote as the project is too far away and the scope of work it 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 f g CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MWBE-2.15`_<=`' 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: 121-016 WBE Participation Goal 6.0% Project Name: Bidder: By: n Paving Round 1 VP of South Bend Area vvt�v rirm V & R Trucking, Inc. Owner or Contact at WBE Firm Veda Godette (Title) (Date) 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 protect. WBE Firm Slusser's Green Thumb. Inc. Owner or Contact at WBE Firm Carolyn Slusser Telephone: 574-722-3102 Fax: TYPE OF WORK SOLICITED FOR THIS PROJECT: Landscar)ina - Seed & Sod RESULTS OF CONTACT WITH THE WBE FIRM: Email: csS slussers.com The firm declined to submit a auote as there is no work for them. Version 01/13/2021 Contractor's Bid for Public Works - 15 CITY OF SOUTH BEND x 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: 121-016 WBE Participation Goal 6.0% Project Name: 2 Contractor Paving Round 1 Bidder- x�ilestone Contractors North Inc. By: VP of South Bend Area 4/13/2021 (ature) 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: bar r)tscpecialists. net TYPE OF WORK SOLICITED FOR THIS PROJECT: Pavement Markings RESULTS OF CONTACT WITH THE WBE FIRM: We'll subcontract with Traffic Control Specialists, Inc. for their work if we are awarded the project. WBE Firm State Barricading, Inc. Owner or Contact at WBE Firm James Michalski Telephone: 574-287-2078 Fax: 574-287-1744 Email: statebarricade1 aol.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 we are awarded 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 W ";'rEF�i.Fai 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: 121-016 WBE Participation Goal 6.0% Project Name: Bidder: By: Contractor Paving Round 1 r ;tone Contractors North Inc. VP of South Bend Area i ature) Dustin Hilary (Title) (Date) 41,11/irm Hawk Enterprises, Inc. Owner or Contact at WBE Firm Greg Neulieb Telephone: 219-662-8090 Fax: 219-662-8093 Email: gre hawk-inc.om _ TYPE OF WORK SOLICITED FOR THIS PROJECT Electrical RESULTS OF CONTACT WITH THE WBE FIRM: The firm declined to submit a quote as there was no work for them. WBE Firm Owner or Contact at WBE Firm Telephone: Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE WBE FIRM: Version 01/13/2021 Contractor's Bid for Public Works - 15 Surety 202B Halls Mill Road, PO Box 1650 Whitehouse Station, M 08889-1650 Federal Insurance Company AIA Document A310TM - 2010 Bid Bond O + 908.903.3485 F + 908.903.3656 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%u Five Percent of the Total Bid PROJECT (Name, location or address, and Project number, if any) 2021 Contractor Paving Round 1, Project No. 121-016 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 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 filrnished 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. :X. Printed in cooperation with the American Institute of Architects (ALA) by Chubb. The language in this document conforms to the language used in AIA Document A310 TM- 2010. Form 15-02-0575-FED (Rev. 3/17) When this Bond has been funushed 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 . ............ (witness) Jackie Dolce day of mil, 2021 Milestone,Contrpi3Oors forth, Inc. Dustin Hilary `0111111111* n ) �%LontractorZ�i��i �e..,,......, . ice Pre$ident� �ORPCRgT�•' (Title) ►� � SEAL ;�.n _: al) e Company _ Angela M. Riley (CorporateSeal) Printed in cooperation with theAmerican Institute of Architects (AM) by Chubb. The language in this document conforms to the language used in ALA Document A310 7m- 2010. Form 15.02-0575-FED (Rev. 3/17) 2 CHUBBa 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 Attorney4n-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 lot day of November, 2019. Aaw�TA. &,WkJe6' Dawn M. Chloros, Assistant Secretary K1'NI (r"M I s m� STATE OF NEW JERSEY County of Hunterdon SS. Stephen M. Haney, Vice President On this 189 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 4 F KhTHEMNE y ACEIAAR XOTAq MMARY PtI9LIC OF NEW JERSIEY a+ P1f8L10 Omm"Isebn Ewphw Juty 116. 4024 Nomy hits 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 of the 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-lo- fact 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 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 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 any such power or authority otherwise valldlygranted 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, @I) the foregoing Power of Attorney is true, correct and In full force and effect Given under my hand and seals of said Companies at Whitehouse Station, NJ, this April 13;f_2021., 5 x� r +a.•� °ar ° �0` • t�'. *' ' r- FF Dawn M. Chloros, Assistant Secretary IN THE EVENT YOU WISH TO VERIFY THE AUTHENT,lCrl`YOFTHiS BOND OR NOTIFY uS-y srr1= aurre4I-LIU wrrAW uAt: Telephonef908i 903. 3493 r' Fax 08 '903- 3656„Lachubb.com Combined: FED-VIG-PI-WFIC AAIC (rev. 11-19) Vrm " a•< CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK RESPONSIBLE BIDDER CHECKLIST Project Name 2021 Contractor Paving Round 1 Project No. 121-016 For Bids Due 9:00 a.m., April 13, 2021, 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. 10694-18 (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 3111 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 I. 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 II. PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED) (a) Acknowledgements: (i) _ By checking this box, I hereby acknowledge that I am not 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 - 9 (ix) _ Written statement of any federal, state or local tax liens or tax delinquencies owed to any federal, state or local taxing body in the preceding three years. (i) _ List of projects of similar size and scope of work performed in all areas, including the State of Indiana, within three (3) years prior to the date on which the bid is due. Date: 4/113/ 1 / G Otractto S��L��i (Sig e) oc:' RPORAr, ••�o~" 100 tin Hilary� 401�rint Name Here) AL .' ' N. Milestone Contractors North, Inc. ��,,'i•. bNblOr►�. �`,,,+` (Name of Company) 24358 SR 23 (Address of Company) South Bend (City) Indiana (State) 574-288-4811 (Telephone Number) Version 01/13/2021 General Conditions - 10 Responsible Bidding Practices and Submission Requirements for Pre -Qualified Bidder Checklist (b) Attachments (i) Attached (ii) 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. By: Dated: April 13, 2021 D)4en Hilary, VP of South Bend Area Part of State Form52414 (R2 / 2-13) 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 2021 Contractor Paving Round 1 Project No. 121-016 Filed April 13th. 2021 Action State Form 52414 (R / 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) 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 13a', 2021 Citv 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 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 12t1', 2021 for the sum of See Attached $ See Attached. The undersigned further agrees to famish a bond or certified check with this bid for an amount specified in the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the notice. Any addendums attached 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 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 1. What public works projects has your organization completed for the period of one (1) year prior to the date of the current bid? Contract Amount Class of Work When Completed Name and Address of Owner $ 12,170,428 Reconstruction May 2019 Walsh Construction $ 5,489,454 Resurface November 2019 Lake County Hwy Dept $ 4,356,212 Resurface December 2019 Cityof 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 Mav 2020 INDOT $ 5,902,953 Reconstruction June 2020 INDOT $ 2,473,069 Reconstruction November 2020 INDOT $ 4,090,509 Resurface July 2020 South Bend Regional Airport 4. Have you ever failed to complete any work awarded to you? No If so, where and why? 3 5. List references from private firms for which you have performed work. Gatlin Plumbing & Heating, Inc. 1111 E. Main St., Griffith, IN Ms. Clara Murphy Gough, Inc. 2200 E. 88' 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 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 Cone. 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 I 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 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 of ri1 2021. `��t��i►�r��i M' sto e CVntractors North Inc. optractors/�, a of Organization) �.♦ C : .. O i 40 P 0 R,4,�, - - )BB SEAL ustin HiIM, VP of South Bend Area .� (Title of Person Signing) ,,��i�� Nbrl aN ��0♦♦• ACKNrWLEDGEMENT STATE OF Indiana } ss COUNTY OF St. Joseph ] 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 13th day of April,. 2021. isha Krueger, Notary Publ c My Commission Expires: June 5. 2022 ,••""""'�o Y P ALISHA KRUEGER Countyof Residence: St. Joseph �e ; Notary p -';SEAL "= Public, State of Indiana St. Joseph county My Commission Expires •�• �R'D I PN4J: June 05, 2022 Form 96 Section II, #2 Subcontractors Used on Public Works Contracts Durin(, the Past 5 Years SUBCONTRACTORS COMPANY ADDRESS CITY/STATE/ZIP PHONE FAX SEWER B & D Sewer 531 Winston Ct Schererville, IN 46375 (219) 322-2300 (219) 865-0065 Deboer Egolf 5772 Melton Road Portage, IN 46368 (219) 763-9700 (219) 763-9703 Delta III 2063 W 1250 S Hanna, IN 46340 (219) 797-4004 (219) 797-3008 Dyer Construction 1716 Sheffield Avenue Dyer, IN 46311 (219) 865-2961 (219) 865-2963 Gatlin Plumbing & Heating 1111 E. Main Street Griffith, IN 46319 (219) 924-6972 (219) 924-1401 Gough, Inc. 2200 E. 88th Drive Merrillville, IN 46410 (219) 756-2200 (219) 756-2202 Grimmer Construction 2619 Main Street Highland, IN 46322 (219) 924-1623 (219) 924-0328 Hasse Construction 10 Lincoln Avenue Calumet City, IL 60409 (219 )932-1611 (219) 932-6829 HRP Construction 5777 Cleveland Rd. South Bend, IN 46624 (574) 271-7800 (574) 271-0524 Rex Construction 700 Schiller Avenue Schererville, IN 46375 (219) 322-8090 (219) 322-0031 Wirtz & Yates, Inc. P.O. Box 41 Kentland, IN 47951 (219) 474-6542 Woodruff & Sons P.O. Box 450 Michigan City, IN 46361 (219) 872-8605 (219) 8795339 MILLING C.E. Hughes Milling, Inc. 3113 Holmans Lane Jeffersonville, IN 47130 (812) 725-8665 (812) 725-8672 Javelina Construction, Inc. 13476 Britton Park Rd. Fishers, IN 46038 (317) 841-8364 (317) 841-0075 Mid America Milling Co. 6200 W. Hwy 62, Ste 400 Jeffersonville, IN 47130 (812) 282-2751 (812) 283-9846 McCrite Milling 209 Quality Ave. Ste 9 New Albany, IN 47150 (812) 941-0252 (812) 941-0852 Specialties Company 9350 E. 30th St. Indianapolis, IN 46229 (317) 594-0291 (317) 594-0271 ELECTRICAL INSTALLATION Hawk Enterprises 1850 E. North St Crown Point, IN 46307 (219) 662-8090 (219) 662-8093 Midwestern Electric 1620 E. Chicago Ave East Chicago, IN 46312 (219) 397-4444 (219) 397-8888 S/T Bancroft Electric 25020 State Road 2 South Bend, IN 46619 (574) 287-6490 Sweney Electric Company 9111 Louisiana St. Merrillville, IN 46410 (219) 769-6007 (219) 769-0565 Trans Tech Electric 4601 Cleveland Road _ South Bend, IN 46619 (574) 272-9673 (574) 271-0144 SIGN INSTALLATION Hawk Enterprises _ 1850 E. North St Crown Point, IN 46307 (219) 662-8090 (219) 662-8093 Midwestern Electric 1620 E. Chicago Ave East Chicago, IN 46312 (219) 397-4444 (219) 397-8888 RoadSafe Traffic Systems 3122 Olympia Dr Lafayette, IN 47909 (317) 780-1825 State Barricading, Inc. 24963 U.S. Highway 20 South Bend, IN 46628 (574) 287-2078 Traffic Control Specialists, Inc. 1810 W Pacific Avenue Knox, IN 46534 (574) 772-7001 (574) 772-7002 PAVEMENT MARKINGS The Airmarking Company P.O. Box 526 Rochester, IN 46975 (574) 223-5817 (574) 223-7959 Blackout Sealcoating 7440 W. 87th Place Bridgview, IL 60455 (219) 864-2300 (708) 430-6910 RoadSafe Traffic Systems 3122 Olympia Dr Lafayette, IN 47909 (317) 780-1825 State Barricading, Inc. 24963 U.S. Highway 20 South Bend, IN 46628 (574) 287-2078 Traffic Control Specialists, Inc. 1810 W Pacific Avenue Knox, IN 46534 (574) 772-7001 (574) 772-7002 Traffic Management Company 3542 Highway Avenue Highland, IN 46322 (291) 746-2433 TRAFFIC CONTROL RoadSafe Traffic Systems 3122 Olympia Dr Lafayette, IN 47909 (317) 780-1825 Traffic Control Specialists, Inc. 1810 W Pacific Avenue Knox, IN 46534 (574) 772-7001 (574) 772-7002 Traffic Management Company 3542 Highway Avenue Highland, IN 46322 (219) 746-2433 LANDSCAPE Great American Landscape P.O. Box 235 Dyer, IN 46311 (219) 322-7033 (219) 322-4419 Hubinger Landscape 210 E. 113th Avenue Crown Point, IN 46307 (219) 662-9911 (219) 662-6206 Slusser's Green Thumb, Inc. 125 Montgomery Street Logansport, IN 46947 (574) 722-3102 (574) 722-1628 T&J 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 r QIIIV CI VII,CA GOV 10 JR LJ IVUIL1I LIUCr Ly, IIV 40004E (A/,+) zoa-azoo Gilmer Trucking 20390 New Road South Bend, IN 46614 (574) 229-3233 Material Transfer Inc. 7811 West 101st Ave. Crown Point, IN 46307 (219) 865-9575 Morris Motor Service, Inc. 10525 W US 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 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 Aoril 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 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 JAMES MUFLLF.R, MAYOR DEPARTMENT OF PUBLIC WORKS ERIC HORVATH, DIRECTOR September 23, 2020 Mr. Dustin Hilary Walsh & Kelly, Inc. dhilarv�;walshkellk .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, Liz Horvath D]m M20A]]]11523B O6O0' 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. 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O N State of Indiana Office of the Secretary of State CERTIFICATE OF EXISTENCE To Whom These Presents Come, Greeting: I, CONNIE LAWSON, Secretary of State of Indiana, do hereby certify that I am, by virtue of the laws of the State of Indiana, the custodian of the corporate records and the proper official to execute this certificate. I further certify that records of this office disclose that MILESTONE CONTR. ACTORS 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 fret 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. 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, March 16, 2021 ewx4ce� C%- ""M CONNIE LAWSON SECRETARY OF STATE 194484-057 / 20211917617 All certificates should be validated here: https://bsd.sos.in.gov/VaiidateCertificate 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'sad 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 dm4c�� C%yj""07�, CONNIE LAWSON SECRETARY OF STATE 194484-057 / 8878219 To ensure the certificate's validity, go to https:Hbsd.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 beeri,-presented to me at my office, accompanied by the fees prescribed by law and that the documentation presented conforms,tolaw as prescribed by the provisions of the Indiana Code. Following said transaction, the above named'entity uvilltransact business under the -assumed business name(s) of:X:. WALSH; &,'KELLY NOW, THEREFORE, with this document I certify that said transaction will become effective Monday, February 01, 2021. In Witness Whereof, I have caused to be affixed my signature and the seal of the State of Indiana, at the City of Indianapolis. February 01, 2021. &M" C%- ""Orv. CONNIE LAWSON SECRETARY OF STATE 194484-057 / 8878234 To ensure the certificate's validity, go to https://bsd.sos.in.gov/PublicBusinessSearch Form-9 Request for Taxpayer (Rev. October2018) 1 Identification Number and Certification Department of the Treasury Internal Revenue Service ► Go to www.1rs.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 line blank. MILESTONE CONTRACTORS NORTH, INC. 2 business namaroisregarded entity name, if different from above WALSH & KELLY, INC. 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven boxes. ❑ Individuallsole proprietor or ❑ C Corporation El S Corporation ❑ Partnership ❑ Tr.Westate 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 (If 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 anyJ 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) ► I rgopres to •mount• nNh, aWoutdde ft u,S� i Address (number, street, and apt. or suite no.) See instructions. Requester's name and address (optional) 700 EAST MAIN STREET B City, state, and ZIP code GRIFFITH, IN 46319 7 Ust account number(s) here (optional) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid 1 Social security number backup withholding. For individuals, this is generally your social security number (SHowever, fora resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other _ m - entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. or Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and [mployer identificatlon number Number To Give the Requester for guidelines on whose number to enter. 3�5 =I! 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 ('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 11, later. Sign signature of 2' j R �� Here U.S. person ► ( I� C� r,1 y (� L � Date ► J 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 wwwJrs.gov/FormW9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information retum. 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 1 D99-S (proceeds from real estate transactions) • Form 1099-K (merchant cans 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 71N, 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. Tracy L. Cross, tive Secretary Certification Board DAPW PQ2 Slate Form 3983R Rev. 07/06 WRITTEN CONSENT TO RESOLUTIONS of the BOARD OF DIRECTORS of WALSH & KELLY, INC. The undersigned, being all of the Directors of WALSH & KELLY, INC., an Indiana Corporation, hereby consent to the following actions to be taken by the Corporation without a meeting of the Board of Directors under the applicable provisions of the Indiana Business Corporation Law, as amended: RESOLVED that the following be, and hereby are, elected officers of the Corporation, to hold the office until the next regular meeting of the Board of Directors and until their successors are duly elected and have qualified: . John M. Peisker, President Jeffrey L. Swan, Executive Vice President John P. Vercruysse, Executive Vice President Jamie L. Tancos, Vice President of Finance, Secretary & Treasurer Gregory A. Kelly, Vice President Charles Potts Jr., Vice President Albert E.VanDenBergh, Vice President David L. Franz, Vice President David J. Misirly, Vice President Gregory A. Hoffman, Vice President Dustin P. Hilary, Vice President Lynn J. Bauer, Vice President Mark E. Krachenfels, Vice President RESOLVED FURTHER that the actions of the Officers of the Corporation taken since the last meeting of the Board of Directors be, and the same hereby are, fully ratified and approved. RESOLVED FURTHER that the following be, and they hereby are, authorized to execute all contracts or similar documents on behalf of the Corporation: John M. Peisker, President Jeffrey L. Swan, Executive Vice President John P. Vercruysse, Executive Vice President Jamie L. Tancos, Vice President of Finance, Secretary & Treasurer Gregory A. Kelly, Vice President Charles Potts Jr., Vice President Albert E.VanDenBergh, Vice President David L. Franz, Vice President David J. Misirly, Vice President Gregory A. Hoffman, Vice President Dustin P. Hilary, Vice President Lynn J. Bauer, Vice President Mark E. Krachenfels, Vice President RESOLVED FURTHER that this consent shall be in lieu of an annual meeting ofthe Board of Directors of the Corporation and shall be filed in the minute book of the Corporation in place of any such annual minutes. <<SIGNATURES ON THE NEXT PAGE>> EXECUTED this 15'h day of January, 2020. Fred Feh e feld, Jr. :;!$�' -- V I 3b Albert E. VanDenBergh Kevin J. Kelly Q. C J •isi James VFebsenfeld V J �PVcricruysse EXECUTED this 15`h day of January, 2020. Fred Fehsenfeld, Jr. Albert E. VanDenBergh Kevin J. Kelly James C. Fehsenfeld John P. Vercruysse EXECUTED this 15'h day of January, 2020. Fred Fehsenfeld, Jr. Albert E. VanDenBergh Kevin J. Kelly f r James C. Fehsenfeld John P. Vercruysse P,iS 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. 1,-) CJ Potts, Chief Operating Officer Margaret Garner, HR Area Partner/EEO Officer February 2021 EOE M/F/Vets/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 Potts, Chief Operating Officer EOE M/FNets/Disabled antintrate of Quatintrati= ISSUED BY �Ixt 4 I=a Rev Jaf QTr=zf mart= 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-'� 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: NAME: WALSH & KELLY INC DATE: 5/21/2020 December 31, 2019 CURRENT FIXED EQUIPMENT ----------------------------------------------------- ASSETS REPORTED $47,119,378.00 $10,219,627.00 $31,032,017.00 VALID: 5/21/2020 LIABILITIES REPORTED ($16,158,151.00) ($16,742,213.00) EXPIRES: 4/30/2021 DENIAL DATE: NET ASSETS REPORTED $30,961,227.00 ($6,522,586.00) $31,032,017.00 DENIAL REASON: 09 OMIT NO DETAIL OR QUANTITY ($4,016,185.00) $0.00 $0.00 11 OMIT NO DETAIL ($277,917.00) $0.00 $0.00 15 CASH SURRENDER VALUE $1,390,248.00 ($1,390,248.00) $0.00 16 OMIT INTANGIBLES $0.00 ($864,210.00) $0.00 22 DUE AFTER 24 MONTHS $0.00 $13,536,060.00 $0.00 NET FIXED ASSETS $0 NET FIXED ASSETS EQUIPMENT $0 COMPONENT ------ - ----------- ---------------------------------------- ---------------------------------------------------------- RATING CURRENT $280,573,730.00 NET ACCEPTABLE ASSETS $28,057,373 $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 + $290,573,730 + $4,759,016 C(B) UNLIMITED $528,829,866 $4,759,016 B(A) UNLIMITED X 0.25 X 2 E(F) $50,000,000 MAXIMUM FIXED $132,207,467 ADJ. FIXED $9,518,032 ------ ------------------- E(E) $25,000,000 BALANCE SHEET ANALYSIS - --------------------- -- E(R) $50,000,000 CURRENT ASSETS: $47,119,378 CURRENT RATIO: 2.916 A(B) $25,000,000 ------------------- ------------------- INVENTORY: $4,016,185 QUICK RATIO: 2.668 E(Q) $25,000,000 --------------------------- CURRENT LIABILITIES: ----------------------- - ---------------------- $16,158,151 WORKING CAPITAL: $30,961,227 E(H) $25,000,000 -------------------------------------------------------------- LONG TERM LIABILITIES: -------------------------------- - --------------------------- ----------------------------------------------- $16,742,213 DEBT/NET WORTH: 0.593 E(G) $25,000,000 NET WORTH: ------------ ------------------------------------------------- $55,470,656 TOTAL LIABILITIES: $32,900,364 NOTES: