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HomeMy WebLinkAboutOpening of Quotes - 2021 Crack Sealing Proj No. 121-020 - Days Construction - AsphaltDAYSAS1 np In- PH .a�ORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) OF INSURANCE 05/10/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 219-769-6616 Rothschild Agency, Inc 8979 Broadway Merrillville, IN 46410- Michael A. Kaim, CIC R -Comm) NC AD Michael A. Kaim, CIC PHONE219-769-6616 FAX (A/C, No, Ext): (AIC, No): E-MAIL INSURERS AFFORDING COVERAGE NAIC # INSURER A: West Bend Mutual 15350 INSURED Day's Construction -Asphalt Inc Robert Day dba INSURER B INSURER C : 855 Taft Street Gary, IN 46404 INSURER D INSURER E INSURER F --- -- — RCVIJIVIV I`IUIY16Cht: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. II TR NSR OF INSURANCE ADDLITYPE ]Nqn WVn SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR 2136639 10/05/2020 10/05/2021 EACH OCCURRENCE $ 1,000,000 PREMISES ( a occurrence) c $ 300,000 MED EXP (Any one arson $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY a jE F� LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMITfEa entl $ BODILY INJURY Perperson) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS E AUTOS ONLY AUOTOS ONL� BODILY BODILY INJURY Per accident $ PerraccidenlDAMAGE A X UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE 2136639 10/05/2020 10/05/2021 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 DED I X I RETENTION $ 10000 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YINA ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? a (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below I N / A 2135679 10/05/2020 10/05/2021 X PER OTH- LITE ER 1000,000 E.L. EACH ACCIDENT $ , E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT 11000,000 A Equipment 2136639 10/05/2020 10/05/2021 Lsd/Rntd 45,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) STJ9007 ST JOSEPH COUNTY CITY OF SOUTH BEND 125 S LAFAYETTE, SUITE 100 SOUTH BEND, IN 46601 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE 4.4wL AUUKU Lb tLU'Ib/UJ) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD WEST BEND A MUTUAL INSURANCE COMPANY" Date: 05/10/2021 Bond Number: 2490838 ROTHSCHILD AGENCY, INC 8979 BROADWAY MERRILLVILLE, IN 46410 PRINCIPAL INFORMATION: Day's Construction Inc. 855 Taft St Gary, IN 46404-1255 Billing Address - if blank, see Principal above: c/o: Obligee Information: City of South Bend & St Joseph County Building Department 125 S Lafayette Blvd Ste 100 South Bend, IN 46601-1575 WB Index: 2490838 Bond Eff Date: 05/10/2021 Bond Exp Date: 05/10/2022 Bond Type: License & Permit Compliance Bond Work Description: Asphalt Contractor Current Bond Limit: $ 5,000.00 Previous Bond Limit: $ 5,000.00 THE SILVER LINING* 13788 IC BOND EXECUTION REPORT Bond Premium: $ 100.00 Premium Change: $ 100.00 THIS IS NOT AN INVOICE MICHIGAN ONLY: This policy is exempt from filing requirements of Section 2236 of the Insurance Code of 1956, 1956 PA 218 and MCL 500.2236. P.O. Box 620976 1 Middleton, W1 53562 1 Phone: (608) 410-3410 1 Pax: (877) 674-2663 1 www,thesilverlining.com WEST BEND A MUTUAL INSURANCE COMPANY' Bond Number 2490838 License and Permit Bond Not valid for Contract, Performance, Maintenance, Subdivision, Supply or Utility Guarantee Bond. Principal: (Full name and address) Day's Construction Inc. 855 Taft St Gary, IN 46404-1255 Effective Date: 05/10/2021 PENAL AMOUNT OF BOND: Five Thousand Dollars and Zero Cents Obligee: (Principal's customer) City of South Bend & St Joseph County 125 S Lafayette_Blvd Ste 100 South Bend, IN 46601-1575 Expiration Date: 05/10/2022 Dollars ($ 5,000.00 lawful money of the United States, to be paid to the said obligee, for which payment well and truly to be made we bind ourselves and our legal representative, jointly and severally. The condition of this obligation is such, that whereas, the principal has been licensed by the Obligee for: Asphalt Contractor NOW, THEREFORE, if said Principal shall faithfully perform all the duties and comply with the laws and ordinances, (including all amendments) pertaining to the license or permit, then this obligation shall be null and void; otherwise to remain in full force unless renewed by continuation certificate. This bond may be terminated at any time by the Surety upon sending notice in writing to the Obligee and to the Principal and at the expiration of thirty-five (35) days from the mailing of notice or as soon thereafter as permitted by applicable law, whichever is later, this bond shall ipso facto terminate and the Surety shall be relieved from any liability for any subsequent acts or omissions of the Principal. Principal shall save and keep harmless the Obligee from all losses or damage which it may sustain or for which it may become liable on account of the issuance of said license and permit. The maximum liability shall not exceed the bond penalty. Signed with our hands and sealed with our seals this, the Day's Construction Inc. (Principal) 10th day of May 20 21 WEST BEN UTUAL I NCE COMPANY to evin A. Steiner, Chief Executive Officer MICHIGAN ONLY: This policy is exempt from the filing requirements of Section 2236 of the Insurance Code of 1956, 1956 PA 218 and MCL 500.2236. NB 0054 11 17 Page 1 of 1 PO Box 620976 1 Middleton, WI 53562 1 Phone: (608) 410-3410 1 Fax: (877) 674-2663 1 www,thesilverlining.com WEST BEND A MUTUAL INSURANCE COMPANY, Rider to Bond Effective 05/10/2021 , this rider is hereby attached to and made a part of Bond No. 2490838 West Bend Mutual Insurance Company hereby agrees and gives consent to revise the information contained in the original bond as follows: Name of Principal: Day's Construction -Asphalt Inc. Address of Principal: 855 Taft St, Gary, IN 46404-1255 Name of Obligee: City of South Bend & St Joseph County Building Department Address of Obligee: 125 S Lafayette Blvd Ste 100 South Bend, IN 46601-1575 Effective Date: 05/10/2021 Expiration Date: 05/10/2022 Bond Penalty: $ 5,000.00 Bond Type: License & Permit Compliance Bond Type of Work: Asphalt Contractor PROVIDED, however, that the liability of the Surety as changed by this rider shall not be cumulative and that all other terms and conditions shall remain the same. WEST BEND MUTUAL INSURANCE COMPANY 4, 4� Name Typed Kevin A. Steiner Dated this 10th day of May 2021 Indicated Change: Name of Company ( seal ) MICHIGAN ONLY: This policy is exempt from the filing requirements of Section 2236 of the Insurance Code of 1956, 1956 PA 218 and MCL 500.2236. NB 0025 0418 Page 1 of 1 PO Box 620976 1 Middleton, W1 53562 1 Phone: (608) 410-3410 1 Fax: (877) 674-2663 1 www.thesilverlining.com WEST BEND A MUTUAL INSURANCE COMPANY" POWER OF ATTORNEY THE SILVER LINING" Bond No. 2490838 Know all men by these Presents, That West Bend Mutual Insurance Company, a corporation having its principal office in the City of West Bend, Wisconsin does make, constitute and appoint: Kevin A. Steiner lawful Attorney(s)-in-fact, to make, execute, seal and deliver for and on its behalf as surety and as its act and deed any and all bonds, undertakings and contracts of suretyship, provided that no bond or undertaking or contract of suretyship executed under this authority shall exceed In amount the sum of: Five Thousand Dollars and Zero Cents 5,000.00 This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of West Bend Mutual Insurance Company at a meeting duly called and held on the 21S1 day of December, 1999. Appointment of Attorney -In -Fact. The president or any vice president, or any other officer of West Bend Mutual Insurance Company may appoint by written certificate Attorneys -In -Fact to act on behalf of the company in the execution of and attesting of bonds and undertakings and other written obligatory instruments of like nature. The signature of any officer authorized hereby and the corporate seal may be affixed by facsimile to any such power of attorney or to any certificate relating therefore and any such power of attorney or certificate bearing such facsimile signatures or facsimile seal shall be valid and binding upon the company, and any such power so executed and certified by facsimile signatures and facsimile seal shall be valid and binding upon the company in the future with respect to any bond or undertaking or other writing obligatory in nature to which it is attached. Any such appointment may be revoked, for cause, or without cause, by any said officer at any time. In witness whereof, the West Bend Mutual Insurance Company has caused these presents to be signed by its president undersigned and its corporate seal to be hereto duly attested by its secretary this 22nd day of Se tember, 2017. Attest Christopher C. Z kart coru'oRArF;_ Kevin A. Steiner Secretary SEAL g; Chief Executive Officer/ President State of Wisconsin County of Washington On the 22nd day of September, 2017, before me personally came Kevin A. Steiner, to me known being by duly sworn, did depose and say that he resides in the County of Washington, State of Wisconsin; that he is the President of West Bend Mutual Insurance Company, the corporation described in and which executed the above instrument; that he knows the seal of the said corporation; that the seal affixed to said instrument is such corporate seal; that is was so affixed by order of the board of directors of said corporation and that he signed his name thereto by like order. _ ••'J; p. 9EN�c�G • • .� LI ;'r107Agy Juli A nedum SeniorCorporate Attorney 4TFOF wlste - Notary Public, Washington Co., WI • My Commission is Permanent The undersigned, duly elected to the office stated below, now the incumbent in West Bend Mutual Insurance Company, a Wisconsin corporation authorized to make this certificate, Do Hereby Certify that the foregoing attached Power of Attorney remains in full force effect and has not been revoked and that the Resolution of the Board of Directors, set forth in the Power of Attorney is now in force. Signed and sealed at West Bend, Wisconsin this 10th day of May 2021 ' SEAL ~` 1; Heather Dunn Vice President — Chief Financial Officer Notice: Any questions concerning this Power of Attorney may be directed to the Bond Manager at NSI, a division of West Bend Mutual Insurance Company. 1900 S. 18,1, Ave. West Bend, WI 53095 1 ph (262) 334-6430 1 1-800-236-5004 1 fax (262) 338-5058 1 «wvw.thesilverliningxom 5110/2021 City of South Bend Vendor Registration City of South Bend Vendor Registration Q✓ Thanks! Your response was submitted. Submit another response Create my own form Powered by Microsoft Forms The owner of this form has not provided a privacy statement as to how they will use your response data. Do not provide personal or sensitive information. Terms of use hftps://forms.office.com/Pages/ResponsePage.aspx?id=5fjdxfV5706GYYHhhsUkuxOkBZYx2ZpFrXWEVel w4wdUQk9XMDc3NzZCQUIlV1 pHVERLR... 1/1 0 FtG CITY OF SOUTH BEND INDIANA r CONTRACTOR'S QUOTE FOR PUBLIC WORK PROJECT NAME: 2021 Crack Sealing PROJECT NO. 121-020 QUOTES DUE May 111", 2021 at 9:00am Local Time. Quotes are to be submitted electronically to )pwi)idS(&�sourht,eiicuin. Date Address: City/State/Zip: (Must be completed for all quotes. Please type or print) Firm:.5 295 Agent of Bidder (if Applicable): Pursuant to notices given, the public works project of: 2021 Crack Sealing Nq Telephone Number: d offers to furnish labor Li L16 material ndcessary to complete the the City of South Bend, Indiana, in accordance with plans and specifications prepared by.- The y: The City of South Bend, Department of Public Works �' and dated � 1 i ' i I for the sum of (enter the Total Quote as shown on the Proposal) 4 i"7.1, 3-0o _ _ ($ ) (Enter Su of Total Quote shown on Proposal) (Numerical) If alternative quotes apply, the undersigned submits a proposal for each in accordance with the notice. Any addendums attached will be specifically referenced at the applicable page. If additional units of material included in the contract are needed, the cost of units must be the same as that shown in the original contract if accepted by the City of South Bend. If the quote is to be awarded on a unit basis, the itemization of the units shall be shown on a separate attachment. Ao By ignature) (Printed Name of Person Signing) The above quote is accepted this Subject to the following conditions: BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Gary A. Gilot, Member Murray Miller, Member Version 2/14/2020 ACCEPTANCE day of Joseph R. Molnar, Member NA Jordan V. Gathers, Member Attest: Anne Fuchs, Clerk Page - 8 Public Works Quote When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON-DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS (Must be completed for all quotes and bids. Please type or print) NOTARY PUBLIC STATE OF ) SEAL SS: STATE OF INDIANA - LAKE COUNTY La k COUNTY ) My commission expires October 6, 2024 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 2/14/2020 Page - 13 Public Works Quote 4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the Contractor subsequently learns is an unauthorized alien. Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of Contractor's newly hired employees through the E -Verify Program as defined by I.C. 22-5-1.7-3. Contractor's documentation of enrollment and participation in the E -Verify Program is included and attached as part of this bid/quote; and 5. Contractor shall require his/her/its subcontractors performing work under this public contract to certify that the subcontractors do not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the subcontractor subsequently learns is an unauthorized alien, and that the subcontractor has enrolled in and is participating in the E -Verify Program. The Contractor agrees to maintain this certification throughout the term of the contract with the City of South Bend, and understands that the City may terminate the contract for default if the Contractor fails to cure a breach of this provision no later than thirty (30) days after being notified by the City. 6. Persons, partnerships, corporations, associations, 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 may consider the Contractor's good faith efforts to obtain participation by those Contractors certified by the State of Indiana as a Minority Business ("MBE") or as a Women's Business Enterprise ("WBE") as a factor in determining the lowest, responsible, responsive bidder. In no event shall persons or entities seeking the award of a City contract be required to award a subcontract to an MBE/WBE; however, it may not unlawfully discriminate against said WBE/MBE. A finding of a discriminatory practice by the City's MBE/WBE Utilization Board shall prohibit that person or entity from being awarded a City contract for a period of one (1) year from the date of such determination, and such determination may also be grounds for terminating the contact for which the discriminatory practice or noncompliance pertains. 7. The undersigned contractor agrees that the following nondiscrimination commitment shall be made a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its agencies, boards or commissions. Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the performance of this contract with privileges of employment, or any matter directly or indirectly related to employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation, handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of contract. Version 2/14/2020 Page -14 Public Works Quote I, the undersigned bidder or agent as contractor on a public works project, understand my statutory obligations to the use of steel products or foundry products made in the United States (I.C. 5-16- 8-1). 1 hereby certify that I and all subcontractors employed by me for this project will use steel products or foundry products made in the United States on this project if awarded. I understand I have an affirmative duty to notify the City in my bid that my proposal does not include the use of steel products or foundry products made in the United States. I understand it is my sole obligation and responsibility to provide a justification to the City, subject to review and approval, why the cost of United States made steel or foundry products is unreasonable. Prior to award and upon submission of bid which does not use steel products or foundry products made in the United States, the City, through its director of public works, shall make a determination if the price of United States made steel or foundry is unreasonable. I understand that violations hereunder may result in forfeiture of contractual payments. I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for public works are true and correct. Dated this day of I "1 , 20 Subscribed and sworn to before m 10 fit %e this �] �f My Commission Expires O6i�U 1D D� q County of Residence lh� Cont actor/Bidder (Firm) /-I— - � A Sig ture of Contractor/ der or Its Agent Printed Name and Title SHEILA DEANGELIA SHINE NOTARY PUBLIC c5EAL k")F :I DIANA - LAKE COUNTY : ')Mrnission expires October 6, 2024 Version 2/14/2020 Page - 15 Public Works Quote QUOTE/PROPOSAL CITY OF SOUTH BEND PROJECT NAME 2021 Crack Sealing PROJECT NO. 121-020 O�Sp11'1'Fr N1111: U \�IfiEii May 11a', 2021 at 9:00am Local Time. Quotes are to be QUOTES DUE submitted electronically to Item No. Description Quantity Unit Unit Price Total Amount 1 Cracks in Asphalt Pavement, Seal 14 TON /00 $ 2 Cracks in Asphalt Pavement, Fill 28 TON t} %40 PGS' $/A 100 Total Amount of Quote $ Firm: Address: City/State/Zip: (7Ati� _ N 41*4 Telephone Number: (a ►.Q ) 3 03 ' L[ (e tp Fax Number: By 4 (Signature) (Printed Narnd of Person Signing) Version 2/14/2020 Page -16 Public Works Quote CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MWBE-1.0 MBE UTILIZATION PLAN This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MWBE participation. It Is the bidder's sole responsibility to verify whether any listed minority or woman business meets the MWBE qualifications. Project Number: 121-020 Project Name: Bidder 1 VId S ►� cS� ILv�ila�'J Bid Amount: MBE Goal: 4.3% Page of Name & Address of MBE Primary Contact Person (Namef telephone) Scope of Work to be Performed (Attach scope/schedule hedule if you need additional space) Dollar Amount of MBE Component Percentage or 1'ct Bid/Pr oral 5 5 ��� sk ��b� C �,a<-1 �►� - SPS �a�� ) 00 �o j 40 ti4 � J�Itoa. Submitted by: � Print Name Signature I Date Version 1113/2021 Page - 17 Public Works Quote CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MWBE-2.0 EVIDENCE OF GOOD FAITH EFFORTS This completed form should be included as part of the Bids documents related to City of South Bend Public Works Projects requiring Good Faith Efforts to obtain MWBE participation. Project Number: 121-020 Date: Project Name: 2021 Crack Sealing Bidder: 11� 4 H s C Ci rJ �bi raw°yo q`z P ki" i Contact Person: �1c 14 Lr,Telephone: Ql t. 3i�3- �4,1)�p Address: A r { City: ( 7 Z /\J State: Z Zip: Email:r{�T YS5 z (ko. s rC M 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': INITIALS 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: http://www.in.clov/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. J I affirm that I reviewed the City of South Bend's Minority and Women Business Enterprise Inclusion Program Plan and the Indiana Department of Administration's certified list of Indiana Minority and Women Business Enterprises, found on their website (http://www.in.gov/idoa). 1 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. k D / I affirm that i have made good faith efforts to solicit through all reasonable and available L/ 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 v MWBEs of contracting and subcontracting opportunities. p p� I affirm that I advertised in general circulation and/or trade association publications i� concerning subcontract opportunities and allowed MWBEs reasonable time to respond to such advertisements. �� (J 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. D / I affirm that I followed up on initial solicitations with interested MWBEs. I affirm that I negotiated with interested MWBEs in good faith, including providing such MWBEs with adequate information about the plans, specifications and other requirements of the subcontract. I affirm that I have made good faith efforts to assist interested MWBEs in obtaining bonding, lines of credit, or insurance as required by the City or the bidder, where appropriate. Version 1/13/2021 Page - 19 Public Works Quote CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MWBE-2.0 EVIDENCE OF GOOD FAITH EFFORTS '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 1/13/2021 Page - 20 Public Works Quote / I affirm that I have made good faith efforts to assist interested MWBEs in obtaining necessary equipment, supplies, materials, or related assistances or services, where -\/ appropriate. .fl 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 1/13/2021 Page - 20 Public Works Quote CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MWBE-2.1 MBE 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 verity whether any listed minority or woman business meets the MBE qualifications. Attach additional pages if necessary. PAGE OF Project Number: 121-020 MBE Participation Goal 4.3% Project Name: 2021 Crack Sealing Bidder: By: ^��cY- (Signature) '� (Title) [ (Date) MBE Firm �`%ie,�4 K) ' t IS p �0, `+ Owner or Contact at MBE Firm -b 16 0-1 T)i�q Telephone: .3 63 . Ll 1�j,L, Fax: Email: Ail ° L., o Q � TYPE OF WORK SOLICITED FOR THIS PROJECT: d+ RESULTS OF CONTACT WITH THE MBE FIRM: MBE Firm Owner or Contact at MBE Firm Telephone: Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBE FIRM: Version 1/13/2021 Page - 21 Public Works Quote