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Home My WebLink AboutOpening of Bids - 2021 Curb and Sidewalk Proj No. 121-001 - Milestone Contractors North, Inc.CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK CHECKLIST FOR BIDDERS Project Name Project No. For Bids Due 2021 Curb and Sidewalk Construction 121-001 June 8, 2021 at 9:00am Local Time to bpwbidsAsouthbe• _ n.ar 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 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: Milestone Contracto r orth, c. Date: 6/8/2021 By Authorized Representatie: Signature: Print Name & Title ustin P. Hilarv. Director of Estimatina. South Bend Version 01/13/2021 Contractor's Bid for Public Works -1 CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK Project Name 2021 Curb and Sidewalk Construction Project No. 121-001 For Bids Due June 8, 2021 at 9:00am Local Time. Sealed electronic bids shall be submitted to b wbids southbendin. ov. PART (Must be completed for all bids. Please type or print) Date: 6/8/2021 Bidder (Firm): Address: 24358 SR 23 Milestone Contractors North, Inc. City/State/Zip: South Bend, IN 46614 Telephone Number: ( 574 ) 288-4811 Agent of Bidder (if Applicable): Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the public works project of: 2021 Curb and Sidewalk Construction the City of South Bend, Indiana, in accordance with plans and specifications prepared by: City of South Bend - DEPARTMENT OF PUBLIC WORKS - DIVISION OF ENGINEERING and dated 3/30/20 & 3/30/21 for the sum of (enter the Total Bid as shown on the Proposal) Six hundred twenty six thousand two hundred ninety seven dollars and fifty cents ($ 626,297.50 (Enter sum of Total Base Bid plus Alternates shown on Proposal) (Numerical) The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the notice. Any addendums attached will be specifically referenced at the applicable page. If additional units of material included in the contract are ded, the cost of units must be the same as that shown in the original contract if accepted by the Cit f oulK Bend. If the bid is to be awarded on a unit basis, the itemization of the units shall be shown 0 ep ate attachment. By The above bid is accepted this Subject to the following conditions: BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Gary A. Gilot, Member (signature) Dustin P. Hilary, Director of Estimating. South Bend (Printed Name of Person Signing) ACCEPTANCE day of Joseph R. Molnar, Member Jordan V. Gathers, Member Murray L. Miller, 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. 1, the undersigned bidder or agent as contractor on a public works project, understand my statutory obligations to the use of steel products or foundry products made in the United States (I.C. 5-16-8-1).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. Version 01/13/2021 Contractor's Bid for Public Works - 5 I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for public works are true and correct. Dated this 8th day of _June , 2021 �T or Its Agent Dustin P. Hilary, Director of Estimatng, South Bend Printed Name and Title Subscribed and sworn to before me this 8th day of June , 20 21 My Commission Expires 6/5/22 Not blic Ala Krueger County of Residence LaPorte Version 01/13/2021 Contractor's Bid for Public Works - 6 t;�Pq •; ALISHA==KRUEGER '`�.•NOTARI�. La P z• ... ;i: My Commun Version 01/13/2021 Contractor's Bid for Public Works - 6 BID/PROPOSAL CITY OF SOUTH BEND Project Name: 2021 Curb and Sidewalk Contruction Project Number: 121-001 For Bids Due: June 8, 2021 at 9:00am Local Time to ;. ,s southbendin.aov Contractor Name: Milestone Contractors North, Inc. DIVISION Al Item No. Description Quantity Unit Unit Price Total Amount 1 CONCRETE SIDEWALK, REMOVE 205 SYS $ 45.00 $ 9,225.00 2 CONCRETE SIDEWALK 4 -IN 205 SYS 1 55.00 $ 11.275.00 3 CONCRETE CURB, REMOVE 365 LFT $ 24.00 $ 8.760.00 4 CONCRETE CURB, MODIFIED 365 LFT $ 45.00 $ 16,425.00 5 CONCRETE APPROACH REMOVE 22 SYS $ 50.00 $ 1,100.00 6 PCCP FOR APPROACHES 6 -IN 22 SYS $ 115.00 $ 2,530.00 7 TOPSOIL AND SEEDING 200 SYS $ 42.00 $ 8,400.00 8 TREE REMOVE. 6 I 1 EA $ 100.00 16 100.00 10 TREE. REMOVE, 18 IN 1 EA $ 500.00 $ 500.00 13 STUMP, REMOVE 1 EA $ 100.00 $ 100.00 14 PLANT, DECIDUOUS TREE, SINGLE STEM, 2 -IN TO 2.5 IN 3 EA $ 1,195.00 $ 3,585.00 15 CURB RAMP, REMOVE 16 SYS $ 100.00 $ 1,600.00 17 PAIRED PERPENDICULAR CURB RAMP 16 SYS $ 120.00 $ 1.920.00 DIVISION Al $ 65,520.00 DIVISION B1 Item No. Description Quantity Unit Unit Price 1 Total Amount 1 CONCRETE SIDEWALK, REMOVE 320 SYS $ 48.00 $ 15,360.00 2 CONCRETE SIDEWALK 4 -IN 320 SYS $ 60.00 $ 19 200.00 3 CONCRETE CURB. REMOVE 575 LFT $ 24.00 $ 13.800.00 4 CONCRETE CURB, MODIFIED 575 LFT $ 48.00 $ 27,600.00 7 TOPSOIL AND SEEDING 320 SYS $ 35.00 $ 11.200.00 11 TREE REMOVE 30 IN 2 EA $ 800.00 $ 1.600.00 13 STUMP, REMOVE 2 EA $ 250.00 $ 500.00 14 PLANT, DECIDUOUS TREE, SINGLE STEM, 2 -IN TO 2.5 IN 4 EA $ 1,045.00 $ 4,180.00 15 CURB RAMP. REMOVE 5 SYS $ 100.00 $ 500.00 16 ONE-WAY PERPENDICULAR CURB RAMP 1 5.0 SYS Is 120.00 $ 600.00 $ 2,890.00 DIVISION B1 $ 94,540.00 DIVISION B2 Item No. Description Quantity Unit Unit Price Total Amount 1 CONCRETE SIDEWALK, REMOVE 170 SYS $ 50.00 $ 8,500.00 2 CONCRETE SIDEWALK, 4 -IN 170 SYS $ 65.00 $ 11,050.00 3 CONCRETE CURB. REMOVE 240 LFT $ 20.00 $ 4,800.00 4 CONCRETE CURB MODIFIED 240 LFT $ 45.00 $ 10,800.00 5 CONCRETE APPROACH, REMOVE 90 SYS $ 45.00 $ 4,050.00 6 PCCP FOR APPROACHES 6 -IN 90 SYS1 $ 80.00 $ 7 200.00 7 TOPSOIL AND SEEDING 135 SYS $ 45.00 $ 6,075.00 10 TREE, REMOVE, 18 IN 2 EA $ 600.00 $ 1,200.00 14 PLANT, DECIDUOUS TREE, SINGLE STEM, 2 -IN TO 2.5 IN 2 EA $ 1,445.00 $ 2,890.00 DIVISION B2 TOTAL $ 56,565.00 BID/PROPOSAL CITY OF SOUTH BEND Project Name: 2021 Curb and Sidewalk Contruction _ _ cj Project Number: 121-001 = For Bids Due: June 8, 2021 at 9:00am Local Time to �{ s Contractor Name: Milestone Contractors North, Inc. �baR DIVISION B3 Item No. Description Quanti Unit Unit Price Total Amount 1 CONCRETE SIDEWALK, REMOVE 240 SYS $ 45.00 $ 10,800.00 2 CONCRETE SIDEWALK. 4 -IN 240 SYS $ 60.00 65.00 14 400.00 3 CONCRETE CURB REMOVE 145 LFT $ 25.00 $ 3,625.00 4 CONCRETE CURB, MODIFIED 145 LFT $ 60.00 $ 8,700.00 7 TOPSOIL AND SEEDING 80 SYS $ 40.00 $ 3,200.00 8 TREE. REMOVE, 6 IN 1 EA $ 200.00 $ 200.00 9 TREE, REMOVE, 10 IN 1 EA $ 400.00 $ 400.00 10 TREE. REMOVE, 18 IN 1 EA 800.00 $ 800.00 13 STUMP REMOVE 1 EA 200.00 125.00 200.00 14 PLANT, DECIDUOUS TREE, SINGLE STEM, 2 -IN TO 2.5 IN 4 $ EA 1,045.00 $ 4,180.00 15 CURB RAMP, REMOVE 10 SYS $ 150.00 $ 1,500.00 16 ONE-WAY PERPENDICULAR CURB RAMP 10 1 SYS $ 300.00 $ 3.000.00 $ 1,705.00 16 ONE-WAY PERPENDICULAR CURB RAMP DIVISION B $ 51,005.00 DIVISION C1 Item No. Description Quantity Unit Unit Price Total Amount 1 CONCRETE SIDEWALK, REMOVE 240 SYS $ 55.00 $ 13,200.00 2 CONCRETE SIDEWAL 4 -IN 240 SYS $ 65.00 $ 15.600.00 3 CONCRETE CURB. REMOVE 405 LFT $ 20.00 $ 8,100.00 4 CONCRETE CURB, MODIFIED 405 LFT $ 40.00 $ 16,200.00 7 TOPSOIL AND SEEDING 225 SYS $ 35.00 $ 7,875.00 10 TREE, REMOVE, 18 IN 2 EA $ 600.00 $ 1,200.00 11 TREE, REMOVE, 30 IN 1 EA $ 2,000.00 $ 2,000.00 14 PLANT, DECIDUOUS TREE, SINGLE STEM, 2 -IN TO 2.5 IN 3 $ EA 1,195.00 $ 3,585.00 15 CURB RAMP. REMOVE 16 SYS $ 125.00 $ 2,000.00 17 PAIRED PERPENDICULAR CURB RAMP 16 SYS $ 195.00 $ 3,120.00 200.00 14 PLANT, DECIDUOUS TREE, SINGLE STEM, 2 -IN TO 2.5 IN 3 DIVISION C $ 72,880.00 DIVISION D1 Item No. Description Quantity Unit Unit Price Total Amount 1 CONCRETE SIDEWALK REMOVE 425 SYS $ 40.00 $ 17 000.00 2 CONCRETE SIDEWALK 4 -IN 425 SYS $ 55.00 $ 23 375.00 3 CONCRETE CURB, REMOVE 675 LFT $ 30.00 $ 20,250.00 4 CONCRETE CURB MODIFIED 675 LFT $ 46.00 $ 31.050.00 5 CONCRETE APPROACH REMOVE 75 SYS $ 45.00 $ 3,375.00 6 PCCP FOR APPROACHES, 6 -IN 75 SYS $ 85.00 $ 6,375.00 7 TOPSOIL AND SEEDING 375 SYS $ 40.00 $ 15 000.00 11 TREE. REMOVE 30 IN 1 EA $ 1,000.00 $ 1,000.00 12 TREE, REMOVE, 48 IN 1 EA $ 4,000.00 $ 4,000.00 13 STUMP REMOVE 1 EA S 200.00 $ 200.00 14 PLANT, DECIDUOUS TREE, SINGLE STEM, 2 -IN TO 2.5 IN 3 $ EA 1,195.00 $ 3,585.00 15 CURB RAMP. REMOVE 15.5 SYS 110.00 $ 1,705.00 16 ONE-WAY PERPENDICULAR CURB RAMP 9 SYS $ 195.00 $ 1.755.00 18 DEPRESSED CORNER CURB RAMP 6.5 SYS $ 195.00 $ 1,267.50 DIVISION D1 TOTAL $ 129,937.50 Project Name: Project Number: For Bids Due: DIVISION D2 BID/PROPOSAL CITY OF SOUTH BEND 2021 Curb and Sidewalk Contruction 121-001 June 8, 2021 at 9:00am Local Time to biwbidsgsouthbendin.cLov Item No. Description Quantity Unit Unit Price Unit Price Total Amount 1 CONCRETE SIDEWALK, REMOVE 90 SYS $ 60.00 $ 5,400.00 2 CONCRETE SIDEWALK 4 -IN 90 SYS $ 75.00 $ 6,750.00 3 CONCRETE CURB REMOVE 225 LFT $ 25.00 $ 5,625.00 4 CONCRETE CURB, MODIFIED 225 LFT $ 54.00 $ 12,150.00 7 TOPSOIL AND SEEDING 136 SYS I $ 50.00 $ 6,800.00 14 PLANT, DECIDUOUS TREE, SINGLE STEM, 2 -IN TO 2.5 IN 1 EA $ 1,995.00 DIVISION E $ 36,725.00 DIVISION E1 Item No.Descri tion Quantity Unit Unit Price Total Amount 1 CONCRETE SIDEWALK, REMOVE 105 SYS $ 40.00 4,200.00 2 CONCRETE SIDEWALK, 4 -IN ]TOPSOIL 105 SYS $ 50.00 $ 5,250.00 3 CONCRETE CURB, REMOVE 200 LFT $ 25.00 $ 5,000.00 4 CONCRETE CURB MODIFIED 200 LFT $ 46.00 $ 9,200.00 7 AND SEEDING 110 SYS $ 45.00 $ 4,950.00 12 TREE, REMOVE, 48 IN 1 EA $ 2,800.00 2,800.00 14 PLANT, DECIDUOUS TREE, SINGLE STEM, 2 -IN TO 2.5 IN 1 EA $ 1,995.00 $ 1,995.00 9,375.00 7 TOPSOIL AND SEEDING 225 DIVISION E $ 33,395.00 DIVISION F1 Item No. Description Quantity Unit Unit Price Total Amount 1 CONCRETE SIDEWALK, REMOVE 255 SYS $ 45.00 $ 11,475.00 2 CONCRETE SIDEWALK, 4 -IN 255 SYS $ 55.00 $ 14,025.00 3 CONCRETE CURB, REMOVE 400 LFT $ 20.00 $ 8,000.F O- 4 CONCRETE CURB, MODIFIED 400 LFT $ 45.00 $ 18,000.00 5 CONCRETE APPROACH, REMOVE 75 SYS $ 90.00 $ 6,750.00 6 PCCP FOR APPROACHES, 6 -IN 75 SYS $ 125.00 $ 9,375.00 7 TOPSOIL AND SEEDING 225 SYS $ 35.00 $ 7,875.00 10 TREE, REMOVE, 18 IN 1 EA $ 1,000.00 $ 1,000.00 11 TREE, REMOVE, 30 IN 1 EA $ 2,000.00 $ 2,000.00 13 STUMP, REMOVE 2 EA $ 200.00 $ 400.00 14 PLANT, DECIDUOUS TREE, SINGLE STEM, 2 -IN TO 2.5 IN 4 EA $ 1,045.00 $ 4,180.00 15 CURB RAMP, REMOVE 10 SYS $ 100.00 $ 1,000.00 18 DEPRESSED CORNER CURB RAMP 10 SYS $ 165.00 $ 1,650.00 DIVISION F1 TOTAL is 85,730.00 Bidder (Firm): Milestone Contractors Norrh, Inc. Address: 24358 SR 23 City/State/Zip: South Bend, IN 46614 4) 288-4811 Dustin P. Hilary, Director of Estimating, South Bend Person Signing) Z J IL V O w IL Z 7 J U Z Z J W U O d M Fe 7 Z xawa :3 LU 0) Z � WE— LL OW0w LLm U� m Z W 2 O 0 Z a N O Z 2 E ca z U CL O O TLN Irl .,0Iti cM i ca O 0 W CD 0 U! ti O N O N c CO E Q m O U C O z L- 0 O U C O U O C: O N N. IE� O r N O d � O � OO CO CL 00 W m o cc O o CL o Q0 ti m M o N � 69 N C CL Ul c CD E CD d (D m � n � o Y w o ami U O N �a U L U f0 Q � � ca o J aao a t r LO U ati U op m 00 m Ez N 00 ad, d U- N U C C W N U m o O N o a 7C/)M L O E C N O JB U z '^ Z r Co N O N 00 c`O O C O E m z c R z Q J a t9 w a z 0 us D J v z oZ a wCJ oa mal7z xaWO LU Z W LL 0 ca M H W O LLI m Uy M M z W M O z a O z_ E c a a CL W m a1 C = O O v >w c - U) 3 V a d W O m Y .c L �+ O y d V d B y 7 N r 'fA d m� w � o E U) 3 O O V � O O �+ c t: w S+ C t/1 R m i •+ 3 3 4)' fl Ly 3 > y o M O M = O CL L L W d d �+ VJ _d N Q O 'D V N t d H r C -I L L6 o cu 0 0 LU (1) 00 � 0 LO O N O TI C CD E 7 z UL C m N f0 O CD 2O m LU o 7� m c � o Q 0 � E _ U `m O Cy o 00 p M H9 a� U C Q m c O O N +_ � C �L a. cu � C 0 0 O N (u 0 o O t CL m ❑. 0-6O F- �o 0 U L � cc c Q (D U) c 0— � w N a= E O M C N =_ 1 017- N o LO a` C) p E -- (D r ILO (O cn Z C�C Q C odO (� 0 _N R �- O co z04 cd !n J T n N O c O m L 0 U) a) E z c CL CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN lr ; i FORM MWBE-2.0',s ' 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: 121-001 Date: 6/8/2021 Project Name: 2021 Curb and Sidewalk Construction Bidder: Milestone Contractors North, Inc. Contact Person: Dustin P. Hilary Telephone: 574-288-4811 Address: 24358 SR 23 City: South Bend State: Indiana zip: 46614 Email: dhilaa@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: http://www.in.gpy/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. 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 (hftp://www.in.gov/idoal. 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 Z 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. r 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 /�G_ PX_ of the subcontract. I affirm that I have made good faith efforts to assist interested MWBEs in obtaining j4- bonding, lines of credit, or insurance as required by the City or the bidder, where +/ appropriate. Version 01/13/2021 Contractor's Bid for Public Works -12 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MWBE-2.0 5 EVIDENCE OF GOOD FAITH EFFORTS I affirm that I have made good faith efforts to assist interested MWBEs in obtaining necessary equipment, supplies, materials, or related assistances or services, where D 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 BEND1 MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MWBE-2.1 fes" 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 1 Project Number: 121-001 MBE Participation Goal 3.7% Project Name: Bidder: / By: 2021 Curb and Sidewalk Construction ne Contractors North, Inc. re) Dustin P. Hilary (Title) f0RE 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: Hauling 6/8/2021 (Date) Email: clee@cleesci.com RESULTS OF CONTACT WITH THE MBE FIRM: If Milestone Contractors North, Inc. is awarded the project, we'll lease C. Lee Construction Services, Inc. for hauling. MBE Firm Owner or Contact at MBE Firm Telephone: Fax: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBE FIRM: Email: Version 01/13/2021 Contractor's Bid for Public Works -14 CITY OF SOUTH BEND o 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 1 OF 1 Project Number: 121-001 WBE Participation Goal 5.5% Project 7/- 2 1 Curb and Sidewalk Construction Bidder: lestone Contractors North. Inc. By: Director of Estimating. South Bend 6/8/2021 gnature) Dustin P. Hilary (Title) (Date) WBE Firm Slusser's Green Thumb. Inc. Owner or Contact at WBE Finn John Williamson Telephone: 574-722-3102 Fax: 574-722-2993 Email: info@slussers.com TYPE OF WORK SOLICITED FOR THIS PROJECT. Seeding, Topsoil & Watering _ RESULTS OF CONTACT WITH THE WBE FIRM: If Milestone Contractors North, Inc. is awarded the pr9ject, we'll subcontract Slusser's Green Thumb Inc. for their work. 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 CM AS U R ETY The Contractor and Surety are bound to the Owner in the amount set forth above, for the payment of which the Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, as provided herein. The conditions of this Bond are such that if the Owner accepts the bid of the Contractor within the time specified in the bid documents, or within such time period as may be agreed to by the Owner and Contractor, and the Contractor either (1) enters into a contract with the Owner in accordance with the terms of such bid, and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a surety admitted in the jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof; or (2) pays to the Owner the difference, not to exceed the amount of this Bond, between the amount specified in said bid and such larger amount for which the Owner may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. The Surety hereby waives any notice of an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for an extension beyond sixty (60) days. If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor. When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the Project, any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefr49�'4iiAtti IJ/r�� provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein. �n 0 actors W. ;........,,�/1ro furnished, the intent is that this Bond shall be construed as a statutory bond and not as a common law bo$c .L:'• '•. �� Signed and sealed this 8th day of June 202J,? Milestone Coo ctoxlorth, Inc. %; CS, A� (Princ (Witness) isha Krueger By: (Tit C ur (Wi ness) Christine ang By (Title) n Hilary, Bend Postma, Attorney -in -Fact Printed in cooperation with the American Institute of Architects (AIA). The language in this document conforms to the language used in AIA Document A310 - Bid Bond - 2010 Edition. LW TSeal) Bond No. Bid Bond CONTRACTOR: SURETY: Continental Casualty Company (Name, legal status and address) (Name, legal status and principal place of business) Milestone Contractors North, Inc. 151 N. Franklin Street 24358 State Road 23 17th Floor South Bend, IN 46614 Chicago, IL 60606 This document has important legal consequences. Consultation with OWNER: an attorney is encouraged with (Name, legal status and address) respect to its completion or modification. City of South Bend Any singular reference to 227 West Jefferson Blvd Contractor, Surety, Owner or South Bend, IN 46601 other party shall be considered plural where applicable. BOND AMOUNT: 5% Five Percent of the Base Bid Plus Any Alternates PROJECT: (Name, location or address, and Project number, if any) 2021 Curb and Sidewalk Construction; Project No. 121-001 The Contractor and Surety are bound to the Owner in the amount set forth above, for the payment of which the Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, as provided herein. The conditions of this Bond are such that if the Owner accepts the bid of the Contractor within the time specified in the bid documents, or within such time period as may be agreed to by the Owner and Contractor, and the Contractor either (1) enters into a contract with the Owner in accordance with the terms of such bid, and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a surety admitted in the jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof; or (2) pays to the Owner the difference, not to exceed the amount of this Bond, between the amount specified in said bid and such larger amount for which the Owner may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. The Surety hereby waives any notice of an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for an extension beyond sixty (60) days. If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor. When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the Project, any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefr49�'4iiAtti IJ/r�� provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein. �n 0 actors W. ;........,,�/1ro furnished, the intent is that this Bond shall be construed as a statutory bond and not as a common law bo$c .L:'• '•. �� Signed and sealed this 8th day of June 202J,? Milestone Coo ctoxlorth, Inc. %; CS, A� (Princ (Witness) isha Krueger By: (Tit C ur (Wi ness) Christine ang By (Title) n Hilary, Bend Postma, Attorney -in -Fact Printed in cooperation with the American Institute of Architects (AIA). The language in this document conforms to the language used in AIA Document A310 - Bid Bond - 2010 Edition. LW TSeal) POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT Know All Men By These Presents, That Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of Hartford, an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company (herein called "the CNA Companies'), are duly organized and existing insurance companies having their principal offices in the City of Chicago, and State of Illinois, and that they do by virtue of the signatures and seals herein affixed hereby make, constitute and appoint Kathryn R. Postma , Individually of Indianapolis, IN their true and lawful Attomey(s)-in-Fact with full power and authority hereby conferred to sign, seal and execute for and on their behalf bonds, undertakings and other obligatory instruments of similar nature - In Unlimited Amounts - Surety Bond No.: Bid Bond Principal: Milestone Contractors North, Inc. Obligee: City of South Bend and to bind them thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of their insurance companies and all the acts of said Attorney, pursuant to the authority hereby given is hereby ratified and confirmed. This Power of Attorney is made and executed pursuant to and by authority of the By -Law and Resolutions, printed on the reverse hereof, duly adopted, as indicated, by the Boards of Directors of the insurance companies. In Witness Whereof, the CNA Companies have caused these presents to be signed by their Vice President and their corporate seals to be hereto affixed on this 27th day of February, 2018. C.A9(!,4(? � tNSUq,1�. _�vpN►pA CORP:FiATf CL , *DRFp411111D O 2 $ JULY 11, D SEAL 7897 � MA11tt"- • Continental Casualty Company National Fire Insurance Company of Hartford American Ca lty Company of Re. ng, Pennsylvania Paul T. Bruflat 14 ice President State of South Dakota, County of Minnehaha, ss: On this 27th day of February, 2018, before me personally came Paul T. Bruflat to me known, who, being by me duly swom, did depose and say: that he resides in the City of Sioux Falls, State of South Dakota; that he is a Vice President of Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of Hartford, an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company described in and which executed the above instrument; that he knows the seals of said insurance companies; that the seals affixed to the said instrument are such corporate seals; that they were so affixed pursuant to authority given by the Boards of Directors of said insurance companies and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said insurance companies. ------------- J. MO HR N6TARYRIdLIC SOUTH U4KOTA� My Commission Expires June 23, 2021 J. Mohr Notary Public CERTIFICATE I, D. Johnson, Assistant Secretary of Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of Hartford, an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company do hereby certify that the Power of Attorney herein above set forth is still in force, and further certify that the By -Law and Resolution of the Board of Directors of the insurance companies printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said insurance companies this 8th day of June, 2021. GAstJ,�ry tNSUR� �ppMpp 16 Ak COnPORAT,t *WM 4tf0 A~ JULY il, ov SEAL f897"- Ar • d� Form 176853=4/20.12 t j 1 Continental Casualty Company National Fire Insurance Company of Hartford Americana Casualty Company of Reading, Pennsylvania V � D. Johnson VAssistant Secretary Go to-ww.w.epa'suretv.com > Owner / Obligee Services > Validate Bond Coverage, if you want to verify bond authenticity. Authorizing Sy -Laws and Resolutions ADOPTED BY THE BOARD OF DIRECTORS OF CONTINENTAL CASUALTY COMPANY: This Power of Attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the Board of Directors of the Company at a meeting held on May 12, 1995: "RESOLVED: That any Senior or Group Vice President may authorize an officer to sign specific documents, agreements and instruments on behalf of the Company provided that the name of such authorized officer and a description of the documents, agreements or instruments that such officer may sign will be provided in writing by the Senior or Group Vice President to the Secretary of the Company prior to such execution becoming effective." This Power of Attorney is signed by Paul T. Bruflat, Vice President, who has been authorized pursuant to the above resolution to execute power of attorneys on behalf of Continental Casualty Company. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the Company by unanimous written consent dated the 25' day of April, 2012: "Whereas, the bylaws of the Company or specific resolution of the Board of Directors has authorized various officers (the "Authorized Officers'�to execute various policies, bonds, undertakings and other obligatory instruments of like nature; and Whereas, from time to time, the signature of the Authorized Officers, in addition to being provided in original, hard copy format, may be provided via facsimile or otherwise in an electronic format (collectively, "Electronic Signatures'); Now therefore be it resolved: that the Electronic Signature of any Authorized Officer shall be valid and binding on the Company. " ADOPTED BY THE BOARD OF DIRECTORS OF NATIONAL FIRE INSURANCE COMPANY OF HARTFORD: This Power of Attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the Board of Directors of the Company by unanimous written consent dated May 10, 1995: "RESOLVED: That any Senior or Group Vice President may authorize an officer to sign specific documents, agreements and instruments on behalf of the Company provided that the name of such authorized officer and a description of the documents, agreements or instruments that such officer may sign will be provided in writing by the Senior or Group Vice President to the Secretary of the Company prior to such execution becoming effective." This Power of Attorney is signed by Paul T. Bruflat, Vice President, who has been authorized pursuant to the above resolution to execute power of attorneys on behalf of National Fire Insurance Company of Hartford. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the Company by unanimous written consent dated the 25' day of April, 2012: "Whereas, the bylaws of the Company or specific resolution of the Board of Directors has authorized various officers (the "Authorized Officers")to execute various policies, bonds, undertakings and other obligatory instruments of like nature; and Whereas, from time to time, the signature of the Authorized Officers, in addition to being provided in original, hard copy format, may be provided via facsimile or otherwise in an electronic format (collectively, "Electronic Signatures'); Now therefore be it resolved: that the Electronic Signature of any Authorized Officer shall be valid and binding on the Company. " ADOPTED BY THE BOARD OF DIRECTORS OF AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA: This Power of Attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the Board of Directors of the Company by unanimous written consent dated May 10, 1995: "RESOLVED: That any Senior or Group Vice President may authorize an officer to sign specific documents, agreements and instruments on behalf of the Company provided that the name of such authorized officer and a description of the documents, agreements or instruments that such officer may sign will be provided in writing by the Senior or Group Vice President to the Secretary of the Company prior to such execution becoming effective." This Power of Attorney is signed by Paul T. Bruflat, Vice President, who has been authorized pursuant to the above resolution to execute power of attorneys on behalf of American Casualty Company of Reading, Pennsylvania. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the Company by unanimous written consent dated the 25' day of April, 2012: "Whereas, the bylaws of the Company or specific resolution of the Board of Directors has authorized various officers (the "Authorized Officers")to execute various policies, bonds, undertakings and other obligatory instruments of like nature; and Whereas, from time to time, the signature of the Authorized Officers, in addition to being provided in original, hard copy format, may be provided via facsimile or otherwise in an electronic format (collectively, "Electronic Signatures"); Now therefore be it resolved: that the Electronic Signature of any Authorized Officer shall be valid and binding on the Company. " CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK RESPONSIBLE BIDDER CHECKLIST Project Name 2021 Curb and Sidewalk Construction Project No. 121-001 For Bids Due June 8, 2021 at 9:00am Local Time to bpwbidspsouthbendin.raov Contractor Name: Milestone Contractors North. Inc. The City seeks to enhance its ability to identify responsive and responsible bidders on all City public works projects by institution of comprehensive submission requirements in compliance with State law. Quality workmanship, efficient operation, safety, and timely completion of projects requires that all bidders meet certain minimum requirements to be responsive and responsible bidders. THIS FORM MUST BE SUBMITTED WITH YOUR BID. INSTRUCTIONS: If you are a pre -qualified bidder, complete Section I only. If you are not a pre -qualified bidder, complete Section II only. Section II acts as an application for pre -qualification. Submission of Section II will allow the bidder to be considered for pre -qualification for bids with the City of South Bend Department of Public Works. Pre- qualified bidders will then be exempt from a portion of the submission requirements outlined in Section 6- 63 of The Responsible Bidding Ordinance No. 10594-18 (hereinafter, 'Responsible Bidding Ordinance") for a period of twelve (12) months. Thereafter, contractors who are pre -qualified must submit a complete application for continuation of "pre- qualified" standing, on a form provided by the City ('Responsible Bidder Checklist (1) Pre -Qualified Bidders") by December 31St for the upcoming calendar year, or within twelve (12) months of obtaining pre- qualified standing. If the status of any item changes within the twelve (12) months, it is the responsibility of the contractor to notify the City. Failure by any pre -qualified contractor to submit its complete application for continuation of "pre -qualified" standing within the time prescribed above shall result in automatic removal of the designation, effective January 1 of the following year, or immediately following the twelve (12) months of pre -qualified standing. However, the "removed" contractor or subcontractor shall still be permitted to bid on City public works projects, though the contractor must submit all required documents under 6-63 until "pre -qualified" status is re-established. Please Note: The City reserves the right to request supplemental information from the bidder, additional verification of any information provided by the bidder, and may also conduct random inquiries of the bidder's current and previous customers regardless of pre -qualified standing. It is the sole responsibility of the potential bidder to comply with all submission requirements applicable to the bidder in Section 6-63 of the Responsible Bidding Ordinance no later than the date of the public bid opening. Version 01/13/2021 General Conditions - 6 POST BID SUBMISSIONS: Post -bid submissions must be submitted in accordance with Section 6-64 of the Responsible Bidding Ordinance. The post -bid submission requirements are as follows: 1. All bidders shall collect, maintain, and provide upon request, a current written list that discloses the name, address, licensing status, and type of work for any subcontractor from whom the bidder has accepted a bid and/or intends to hire on any part of the public work project, including individuals performing work as independent contractors. 2. Each subcontractor, whose portion of the project is estimated to be at least one -hundred fifty thousand dollars ($150,000.00), shall be required to adhere to the requirements of Section I of the Responsible Bidder Ordinance as though it were bidding directly to the City, except that the subcontractor shall submit the required information (including the name, address, and type of work) to the successful bidder prior to the commencement of work. 3. Failure of a subcontractor to submit the required information shall not disqualify the successful bidder from performing work on the project and shall not constitute a contractual default and/or breach by the successful bidder. However, the City may withhold all payment otherwise due for work performed by a subcontractor, until the subcontractor submits the required information and the City approves such information. 4. The disclosure of a subcontractor list ("Disclosed Subcontractors)") to the City by a bidder shall not create any rights in the Disclosed Subcontractor(s). Thus, a bidder may substitute another subcontractor for a Disclosed Subcontractor by giving the City, upon request, written notice of the name, address, licensing status, and type of work of the substitute subcontractor. 5. The successful bidder and all subcontractors on a public works project are required to submit certified payroll utilizing the federal form known as WH -347 or a similar form on a bi-weekly basis, submitted within 10 days after the end of each bi-weekly payroll period. Certified payrolls shall identify the job title and craft for each employee. Certified payrolls shall be submitted electronically. Please Note: Submissions deemed inadequate, incomplete, or untimely by the City may result in the automatic disqualification of the bid. The City, after review of complete and timely submissions, shall, in its sole discretion, after taking into account all information in the submission requirements, determine whether a bidder is responsive and responsible, and provide a Pre -Qualification Verification Letter. The City specifically reserves the right to utilize all information provided in the contractor's submission and any information obtained by the City through its own independent verification of the information provided by the contractor. Version 01/13/2021 General Conditions - 7 PRE -QUALIFIED BIDDER CHECKLIST (a) Acknowledgements: (i) X By checking this box, I hereby acknowledge that I am a pre -qualified bidder with the City of South Bend and that I have met the pre -qualification requirements within the last twelve (12) months. A copy of my Pre -Qualification verification letter is attached. (ii) X By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided by me, and may also conduct random inquiries of my current and prior customers. (b) Attachments: (i) X Indiana Secretary of State's on-line records (ie. Business verification) dated within sixty (60) days of the submission of said document showing that business is in existence, current with the Indiana Secretary of State's Business Entity Report, and eligible for a certificate of good standing. (Not applicable to individuals, sole proprietors or partnerships). (ii) X Statement on staffing capabilities, including labor sources. This statement indicates and ensures I have sufficient employees on staff to complete the work. It outlines how I intend to meet the staffing needs of the work. (iii) X List of projects of similar size and scope of work performed in all areas, including the State of Indiana, within the last three (3) years. (iv) X For every project, submit evidence of participation in apprenticeship and training programs, applicable to the work to be performed on the project, which are approved by and registered with the United States Department of Labor's Office of Apprenticeship, or its successor organization. Version 01/13/2021 General Conditions - 8 PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED) (a) Acknowledgements: (i) _ By checking this box, I hereby acknowledge that I am not a pre -qualified bidder with the City of South Bend. (ii) _ By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided, and may also conduct random inquiries of my current and prior customers. The City reserved the right to utilize all information provided in this submission and all information obtained in inquiries or requests to determine if a bidder is responsive and responsible. Additionally, I acknowledge that all information provided to the City shall be regarded as public records. (iii) _ By checking this box, I hereby acknowledge that copies of all Applicable apprenticeship certificates or standards for training programs applicable to the work performed on the project may be requested at any time and shall be furnished upon request. (iv) _ By checking this box, 1 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. Milestone Contractors North, Inc. (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 Milestone Contractors North, Inc. GRIFFITH 1700 E. Main St. Griffith, IN 46319 Phone: (219) 924-5900 Fax (219) 924-8768 SOUTH BEND 24358 SR 23 South Bend, IN 46614 Phone: (574) 288-4811 Fax (574) 289-7174 Responsible Bidding Practices and Submission 1. Attached 2. 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. 3. See Attached Forms 96 & 96a 4. Milestone Contractors North, Inc. is signatory with the following unions which supply our workforce — Laborers International Union, Teamsters, Operating Engineers and Cement Masons Dated: June 8, 2021 CITY OF SOUTH BEND JAMES MUELLER, MAYOR DEPARTMENT OF PUBLIC WORKS ERIC HORVATH, DIRECTOR September 23, 2020 Mr. Dustin Hilary Walsh & Kelly, Inc. dhilM Lcywalshkelly.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 $150,000 submitted to the City of South Bend Board of Public Works, along with your Pre -Qualified Bidder Checklist and attachments. If you have any further questions regarding this matter, please call this office at (574) 235- 9251. Sincerely, Dirytall F " Liz Horvath Liz Horvath MAHLiz Horvath,go0. email=lharvathtasouMhendin.gov, US Nle: Dote: 2020,0923 11 S2;38 -00'00' Liz Horvath, Permit Manager 1/10/2019 2:42 PH FROM: 110EITS 70: +12188248789 P. 3 `ygg� � INTARNAT1ONAL UNION OSP OPBRATMG ENGINEER8 �wc^m �.+.w.,w•ism, �oe.c..,..,.a�.....� C' � I Y� � )� o�w JAN,6 m. SWEENEY .a m H Jsausry 10,3019 Walsh & Kelly 1700 E Main St. iN 46319 GriW&% �{/� Pc Ptwfile NompM3 with 302[.CS s0U70•Zt(6) purFile Ha. Ml -00321 to 01 yes h U30) �' •� _ Dru Sita Madam: tion Ma m0 � 'i�"'t Al the request of Wetsb & Kelly Jae, I em providing ym with midrnceof the Caanynps comylivnce with tie appmdicwhip regwreincnhm 30 ILCS,SMO-22(6) offt Illinois Fmeuremmt Loch I mm suhmitling this letter alongwith up mhctelnpcertif ales - ? p� fit y. -Lm` 1Vw:l. (Nos.(1A12020W3 and 110 EM113). As a aignatory contractor with the hltemstitmal Uuion ofOpereting EvaincoM Local ISO, AFL-MCh WgUh & Kdly Inc, is tequ-ird by Ca➢eaivc Bargaining Agmsnerd to -may 4 f4 c,{.� ,� '� lr�r. participate in me mWicbksppradioabip and training Pm9rm gpmved by Anil r4istaedwithdoUnitdStates DeparmsratofLabor's!imamdApprmdiceshipAnd fy' Q tp� c O O V haat► Training. The attach d certifiates are, evidence ofcampliancewitl•. tete U.S. Department of Labor's appre.0— ipr rim omen. 7bankyouforymrawpmtioningdemsua. Ifyou have any question a ooneems, me do not he plesitate io contact me 33 [�7 ', Very-ly)-m >J b N �r.L .c y NO6, Local ISD, AFL-CIO LNm+iet I dicpetch office ob 4im13oe Lemiek }' A2 Fsclosiacs: Cerfifiutes Ali •�. "19M ;SXM RdZt:Z BTMOTJT 9 'd GSLGtZOMT+ sirmw ikvu jidat:z STOZ/0117 ntrnUM LABOBYasr7RANNG TBEISTFUND A"adfA ,> � JftXBQft h,Farera &o6mf& Wr$iu P.O.Hoi7aB-Bedfoad, ]adYma a7e21 bb— C--lfA Db NAIL (817)2795515 f C Nt21x79s7st ri 1==y 14, 2019 RZ m p M Jew is to wafirm fie "Walsh & Eft hr. " is a dgmixy comer in Swd „iLmckdmllabo ac'MixftMootFmd. 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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 . 2021 Curb and Sid w I Pro ect N . 12 -0 (Governmental Unit) in accordance with plans and specifications prepared by City of South Bend, Indiana -Department of Public Works -and dated 3/30/2020&3/30/2021 for the sum of Division o ngineering See Attached _ _ _ _ . $ See . 1.=hed _ _ The undersigned further agrees to fumish a bond or certified check with this bid for an amount specified in the notice of the letting. If altemative 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 an 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 (!f 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). 1 hereby certify that I and all subcontractors employed by me for this project will use U.S. steel products on this project if awarded. I understand that violations hereunder may result in forfeiture of contractual payments. ACCEPTANCE The above bid is accepted this _ day of . subject to the following conditions: Contracting Authority Members: PART II (For projects of $150, 000 or more —1 C 36-1-12-4) Governmental Unit: City of South Bend, Indiana _= Bidder (Firm) Milestone Contractors North, Inc._ _ Date (month, day, year): _ June 8 2021 These statements to be submitted under oath by each bidder with and as a 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? Completion Contract Amount Class of Work _Date Name and Address of Owner 9,946,272.00 Reconstruction Mai 2020 INDOT 87,140.00 Resurface November2020 Lake County Hwy Dept 04,874.00 Resurface December 2020 St. Joseph County_ Airport Authority 3,698,954.00 Resurface October 2020 _ INDOT 2. What public works projects are now in process of construction by your organization? Expected Contract Amount Class of Work Completion Name and Address of Owner Date _ 6,917,653.00 Resurface I M y 2021_ INDOT 6,716,400.00 ReconstructionL December 2021 INDOT 5,126, 831. 00 Reconstruction - November 2021 INDOT 3,338,539.00 ^Reconstruction/Sewer December 2021 INDOT 3. Have you ever failed to complete any work awarded to you? No If so, where and why? 4. List references from private firms for which you have performed work. Gatlin Plumbing & Heating, Inc. 1111 E. Main St., Griffith, IN Ms. Patti Centrowski Gough, Inc. 2200 E. 88th Dr., Merrillville, IN Mr. Raymond Gough Dyer Construction Co., 1716 Sheffield Avenue, Dyer, IN Ms. Janet Furman Grimmer Construction Co., Inc. 2619 Main St., Highland, IN Mr. Greg Grimmer SECTION 11 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, complete the project, number of workers, etc. and any other information which you believe would enable the governmental unit to 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 govemmentai unit in the event that you subsequently determine that you will use a subcontractor on the proposed project. Will supply upon award of contract _ 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. See attached list 5. Have you entered into contracts or received offers for all materials which substantiate the prices used In preparing your proposal? If not, 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 include 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 PUBLIC WORKS ARE TRUE AND CORRECT. Dated at South Bend this By STATE OF Indiana ) ss COUNTY OF St. Joseph a day of June 2021 Hilary _Director of Estimating, South Bend (rifle of Person Signing) ACKNOWLEDGEMENT Before me, a Notary Public, personally appeared the above-named Dustin P. Hilary swore that the statements contained in the foregoing document are true and correct. and Subscribed and sworn to before me this 8th _ day of June NotaryPubfic Alisha Krueger My Commission Expires:. . 6/5/22 l'4 I ;t+PyB ALISHA KRUEGER Mpg �orV • = La Porte County County of Residence: Lal? o a SEAL My Commission Expires June 5, 2022 0 �R V MI N 00 M N O N_ C 0 U 0 W 0�/ f0 LL O o z (1) N o ° °' o o 0 00U Z 4 -o � VO d J m U U m a N O N C LL Q 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. Address 1700 E. Main St. Griffith. IN 46319 Date submitted June 8t' 2021 Filed A.E. BOYCE CO., MUNCIE, IND. 1 {A Corporation Sec. 2 of an Act entitled AN ACT concerning the awarding of contracts for the performance of public work and authorizing the board of accounts to prescribe certain forms to be used in ascertaining the responsibility of contractors who submit bids for the performance of such work, providing for plans and specifications, providing for bids repealing certain laws and declaring an emergency." (Approved March 13, 1947.) Sec. 2. Whenever the aggregate costs of any work or improvement will be five thousand dollars ($5,000.00) or more, for the purpose of enabling such board, commission, trustee, officer or agent to ascertain and determine which of the bidders submitting bids for the performance of any such public work is, in the judgment of such board, commission, trustee, officer or agent, the lowest and/or best bidder and to exercise intelligently the discretion hereby conferred on such board, commission, trustee, officer or agent each bidder shall be required to submit under oath with and as a part of his bid a statement of his experience, his proposed plan for performing such work and the equipment which he has available for the performance of such work and a financial statement. The statements hereby required shall be submitted on forms which shall be prescribed by the state board of accounts. The forms so prescribed shall be designated, respectively, as the experience questionnaire, the plan and equipment questionnaire and the contractor's financial statement, and shall be based, so far as applicable, on the standard questionnaires and financial statement for bidders as approved and recommended by the joint conference on construction practices, for use in investigating the qualifications of bidders on public construction work, and the forms so prescribed are hereby prescribed as the forms which shall hereafter be used by all such boards, commissions, trustees, officers and agents in obtaining the information which is required in the administration of this act. If the information submitted by any bidder on the forms herein prescribed is found, on examination, to be unsatisfactory, the bid submitted by such bidder shall not be considered. (Burns Statutes 1933, Sec. 53-109) Sec. 2, Chapter 306, Acts of 1947. TO THE BIDDER— The following forms of questionnaires and financial statement are prescribed by the State Board of Accounts in conformity with the statute set out on the preceding page. These forms, properly filled out and attested, must accompany each bid of five thousand dollars or more on any public work. The forms are designed to cover all contracts for all kinds of work and the bidder is required to answer such questions as are pertinent to the work upon which he is bidding. The purpose of the questionnaire and financial statement, as set forth in the law, is to enable the awarding body to determine the qualifications of the bidder to carry out successfully the contract if the same is awarded to him. The bidder will find it to his advantage to answer fully all questions coming within the range of the work upon which he is bidding. Particular attention should be given the "Financial Statement" and the details relative to the assets and liabilities set out. This form is made in extensive detail so that the bidder may explain his assets and liabilities in proper sequence and in a uniform manner. T. M. HINDMAN, State Examiner Submitted by Milestone Contractors North. Inc. { x A Corporation Principal Office at 1700 East Main Street, Griffith, IN 46319 To City of South Bend, Indiana EXPERIENCE QUESTIONNAIRE The signatory of this questionnaire guarantees the truth and accuracy of all statements and of all answers to interrogatories hereinafter made. 1. How many years has your organization been in business as a general contractor under your present business name? 55 Years 2. How many years experience in asphalt paving_ construction work has your organization had: (a) As a general contractor 74 years (b) As a sub -contractor 74 Years What projects has your organization completed? Contract Amount Class of Work When Completed Name and Address of Owner $ 9,946,272 Reconstruction May 2020 INDOT $ 4,287,140 Resurface November 2020 Lake County Hwy Dept $ 4,104,874 Resurface Resurface December 2020 St. Joseph County Airport Authority $ 3,698,954 October 2020 INDOT 3-A. What projects has your organization now in process of construction? CONTRACT AMT. CLASS OF WORK WHEN TO BE COMPLETED NAME AND ADDRESS OF OWNER $ 6,917,653 Resurface May 2021 INDOT $ 6,716,400 Reconstruction December 2021 INDOT $ 5,126,831 Reconstruction November 2021 INDOT $ 3,338,539 Reconstruction/Sewer December 2021 INDOT 4. Have you ever failed to complete any work awarded to you? No If so, where and why? 5. Has any officer or partner of your organization ever been an officer organization that failed to complete a construction contract? No If so, other organization and reason therefore_ )r partner of some other state name of individual, 6. Has any officer or partner of your organization ever failed to complete a construction contract handled in his own name? No If so, state name of individual, name of owner and reason therefor 7. In what other lines of business are you financially interested? None 4 8. For what corporation or individuals have you performed work, and to whom do you refer?_ BP Amoco, Whiting, Indiana Tonn & Blank Construction 1623 Greenwood Ave., Michigan City, IN 46360 Grimmer Construction Co., Inc. 2619 Main Street, Highland, IN 46322 University of Notre Dame, South Bend, Indiana Gough, Inc., 1151 E. Summit, Crown Point, IN 46307 For what cities have you performed work and to whom do you refer? Town of Griffith Director of Public Works Griffith, IN Town of Schererville Town Manager _ Schererville, IN City of Hammond City EnjZineer Hammond IN City of South Bend City Engineer South Bend, IN Town of St. John Town Manager St. John, IN Elkhart County I-EjzhwU 10. For what counties have you performed work and to whom do you refer? Lake Count I-Ejzhwgy YEARS OF Superintendent Crown Point IN Porter County Highway CONSTRUCTIO SWerintendent Valparaiso, IN St. Joseph County Highway N EXPERIENCE Su erintendent South Bend IN Elkhart County I-EjzhwU 35 Superintendent ElkhartIN Laporte County Highway 41 Superintendent La orte IN 11. For what State bureaus or departments have you performed work and to whom do you refer? Indiana Department of Transportation INDOT LaPorte District La orte IN Department of Natural Resources Indianapolis, IN 12. Have you ever performed any work for the U.S. Government If so, when and to whom do you refer? U.S. Army Corps of Engineers Chicago, IL Indiana National Guard, D t. of Administration Indiana olis IN Federal Highway Administration Sterling, VA 13. What is the construction exverience of the Drincipal individual of vour oreanization? INDIVIDUAUS NAME PRESENT POSITION OR YEARS OF MAGNITUDE AND IN WHAT CAPACITY OFFICE CONSTRUCTIO TYPE OF WORK N EXPERIENCE Todd A. Fawver President 35 All Types Engineer Mark S. Andrews Exec. Vice President 41 All Types General Manager John M. Peisker VP — Production 36 All Types General Manager Jamie L. Tancos Vice President, 17 Administration General Manager Secret /Treasurer David M. Kozyra VP, Area Manager 26 All Types Project Manager Griffith Greg A. Hoffman Director of 34 Bituminous Paving Engineer Estimating, Griffith David J. Misirly Senior Estimator 36 Bituminous Paving Engineer Mark E. Construction Manager 31 All types Engineer Krachenfels Lynn J. Bauer VP, Area Manager 26 All types Engineer South Bend Dustin P. Hilary Dir. of Estimating, 21 All types Engineer South Bend Nikolas G. Relias Project Manager 19 Bituminous Paving Engineer PLAN AND EQUIPMENT QUESTIONNAIRE The signatory of this questionnaire guarantees the truth and accuracy of all statements and of all answers to interrogatories hereinafter made. 1. In what manner have you inspected this proposed work? Explain in detail. Plans, Specifications. and Site Inspections 2. Explain your plan or layout for performing the proposed work As directed by owner/engineer 3. The work, if awarded to you, will have the personal supervision of whom?_ Todd A. Fawver, John M. Peisker, Mark S. Andrews David J. MisiLly, Gregga A. Hoffman, Dustin P. Hil David M. KonTa, and Lynn J. Bauer 4. *Do you intend to do the hauling on the proposed work with your own forces? Yes If so, give amount and type of equipment to be used As needed *If you intend to sublet the hauling or perform it through an agent, state amount of sub -contract or agent's contract, and if known, the name and address of sub -contractor or agent, amount and type of his equipment and financial responsibility Items 4,5,6 and 7 may not be applicable in all building contracts; if not, omit. 6. *Do you intend to do the grading on the proposed work with your own forces? If so, give type of equipment to be used 7. *If you intend to sublet the grading or perform it through an agent, state amount of sub -contract or agent's contract, and, if known, the name and address of sub -contractor or agent, amount and type of his equipment and financial responsibility 8. Do you intend to sublet any other portions of the work? If so, state amount of sub -contract, and, if known, the name and address of the sub -contractor, amount, and type of this equipment and financial responsibility 9. From which sub -contractors or agents do you expect to require a bond? None 10. What equipment do you own that is available for the proposed work? QUANTITY UEM DESCRIPTION, SIZE, CAPACITY, ETC. CONDITION YEARS OF SERVICE PRESENT LOCATION 5 Asphalt Plants Various Good Griffith, South Bend, Val araiso, Lowell, LaPorte 20 Asphalt Pavers Various Good' Griffith, South Bend 4 Sli form Conc. Paver Various Good Griffith, South Bend 4 Road Widener Various Good Griffith, South Bend 4 Motor Graders CAT/J.D. Good Griffith, South Bend 57 Rollers Various Good Griffith, South Bend 39 Rubber Tire Loaders Various Good Griffith, South Bend 22 Excavators Various Good Griffith, South Bend 8 Bulldozers Various Good Griffith, South Bend 7 LowBoy Tractors Various Good Griffith, South Bend 9 Flatbed Dumps Various Good Griffith, South Bend 59 %z and % ton Pickups Various Good Griffith, South Bend 66 1 Ton Crew Trucks Various Good Griffith South Bend 3 Cold Planers Wirtgen 1900 DC Good Griffith, South Bend 78 1 Quad/Tri-Axle Dump Mack I Good Griffith, South Bend 11. What equipment do you intend to purchase for use on the proposed work, should the contract be awarded to you? QUANTITY ITEM DESCRIPTION, SIZE, CAPACITY, ETC. APPROXIMATE COST None 12. How and when will you pay for the equipment to be purchased? N/A 13. Do you propose to rent any equipment for this work?No If so, state type, quantity and reasons for 14. Have you made contracts or received firm offers for all materials within prices used in preparing your proposal? Do not give names of dealers or manufacturers Dated at South Bend,,,00 "111li this � ontrd; i'�`� c: •�S 4 . ��P0RATF c. !� SEALS i Ni ;p�``�� STATE OF Indiana t SS. COUNTY OF. LaPorte 8' day of June, 2021. (Name �0 rWstin P. Hilary Director of Estimati of Person Signing) Dustin P. Hilary _ being duly sworn deposes and says that he is Director of Estimating; South Bend of the above Milestone Contractors North, Inc.. (Name of Organization) and that the answers to the questions in the foregoing questionnaires and all statements therein contained are true and correct. Subscribed and sworn to before me this 8' day of June 2021. Alis 2ekger. Notary Public My Commission expires June 5, 2022 ALISHA KRUEGER 2"_raornav . La Porte County My Commission Expires �qcj June 5, 2022 Contractor's Financial Statement Submitted by Milestone Contractors North Inc. {x A Corporation With principal office at 1700 E. Main St. Griffith. IN 46319 To Citv of South Bend, Indiana Condition at close of business December 31. 2020 ASSETS 1. Cash: (a) On hand 1 124 ; (b) In Bank $ 21.273308 .,_(C Elsewhere $--- Dollars and Cents. 21,274,432 2. Notes receivable: a Due within 90 dais 0 (b} Due after 90ays 0 (c ). Past due 0 _ _ _ 3. Accounts receivable from co_mQleted contracts, exclusive of claims not ap rp oved for payment 9,466,018 4. Sums earned on uncompleted contracts as shown by engineer's or architect's estimate 0 (a) Amount receivable after deducting rets^ inage — 6,862,582 (b) Retainage to date, due upon completion of contracts 924,986 5. Accounts receivable from sources other than construction contracts 38,223 6. Deposits for bids or other guarantees: (a) Recoverable with 90 des _ _ 0 --(b) Recoverable after 90 days0 0 0 7. Interest accrued on loans, securities, etc. — 0- 8. Real estate: _(a) Used for business purposes 8.427; 413_ — _ — Not used for business purposes — 0 9. Stocks and bonds _ (a Listed - present market value —_ 0 (b) Unlisted - present value u 0 10. Materials in stock not included in Item 4 (a) For uncompleted contracts resent valued X215_ 421 (b) Other materials resent value 0 11. Equipment book value 31 806,565 _ _ _ 12. Furniture and fixtures, book value 411,235. 13. Other assets — 4,932,130 — _ _ _ _ Total assets 89,359,005 LIABILITIES 1. Notes. payable —��To banks rem — 3,000,000 _— (b) To banks for certified checks 0. _ (c) To others for equipment oblijzations _v - 12,332 898 ___--- (d) To others exclusive of equipment obligations 0 _ - 2. Accountable: tea) Nogast due _ _ 4,479,803 (b) Past due 0 _ _ .—_ 3. Real estate_ encumbrances 0 �- _ —_— 4. Other liabilities 11,636,485 --- _ 5. Reserves _ 6. Capital stock paid up: (a) Common ---- _ _ _ _0 10 000 ^ ---- - --- -__ -- fib) Common (c) Preferred 0 0 _.— 0 7. Surplus (net worthy _ _ _ _ _— — —_ .............�- — 57,899,819 — _ _ _ — Total liabilities CONTINGENT LIABILITIES— 89,359,005 1: Liability on notes receivable, discounted or sold _ -- — 0 - -- 2. Liabilityon accounts receivable, pleA&ed, assigned or sold — —_------ 0 3. Liability as bondsman _ _ _— — 0 4_ Liability as guarantor on contracts or on accounts of others _ 0 5. Other contingent liabilities ...... ..... __ Total contingent liabilities — 0 0 DETAILS RELATIVE TO ASSETS 1 Cash a on hand _ (b) deposited in banks named below c elsewhere - state where .._ 1,124 21,273,308 0 NAME OF BANK LOCATION DEPOSIT IN NAME OF AMOUNT Centier Bank Mishawaka, IN Milestone Contractors North, Inc. 18,751,445 Centier Bank Mishawaka, IN Omega Trucking Co., Inc./South Bend Transfer Ltd. 2,373,288 Centier Bank Mishawaka, IN WK Land Acquisition, LLC 144,675 Wells Fargo Bank Indianapolis, IN WK Land Acquistion, LLC/South Bend Transfer Ltd. 3,900 2* a due within 90 days Notes receivable (b) due after 90 days cpast due _ 0 0 0 RECEIVABLE FROM: NAME AND ADDRESS FOR WHAT DATE OF MATURITY HOW SECURED AMOUNT ---- 617,318 Other/Misc 73,080,349 41,833,788 37,386,991 2021 756,608 4 446 797 Totals 98,265,122 54,893,512 48,030,930 924,986 6,862,582 Have any of the above been discounted or sold? No If so, state amount, to whom and reason N/A 3 * Accounts receivable from completed contracts exclusive of claims not approved for payment $9,466,018 NAME AND ADDRESS OF OWNER NATURE OF CONTRACT AMOUNT OF CONTRACT AMOUNT RECEIVABLE L. Keela Construction l contract Asphalt Paving 1,007,207 1,007,207 City of Mishawaka 3 contracts Asphalt Pavin 5,380,132 1,133,094 BR2C 1 contracts Asphalt Paving 234,625 234,625 Garin Construction 4 contracts Asphalt Paving 824,926 1 319,227 City of South Bend, IN. 6 contracts Asphalt Paving_ 1,451.092 483,955 Other/Misc. Asphalt Paving 1 6,287,910 Have any of the above been assigned, sold, or pledged? No If so, state amount, to whom, and reason 4 * Sums earned on uncompleted contracts, as shown by engineer's or architect's estimate: (a) Amount receivable after deducting retainage_ $ 6,862,582 (b) Retainage to date due upon completion of contract 924,986 DESIGNATION OF CONTRACT AND NAME AND ADDRESS OF OWNER AMOUNT OF CONTRACT AMOUNT EARNED AMOUNT RECEIVED RETAINAGE AMOUNT EXCLUSVIE OF REATINAGE WHEN DUE AMOUNT INDOT 5 contracts 17,547,086 9,604,192 9,415,363 2021 ---- 188,829 Gary Material Supply, Inc. (1 contract 1,984,643 1,683,072 429,119 2021 168,378 1,253,953 ReEne ize 1 contract 3,836,503 355.494 191 2021 ---- 355,685 BP Amoco 1 contract 1,816,541 1,416,966 799,648 2021 ---- 617,318 Other/Misc 73,080,349 41,833,788 37,386,991 2021 756,608 4 446 797 Totals 98,265,122 54,893,512 48,030,930 924,986 6,862,582 Have any of the above been sold, assigned, or pledged? No If, so, state amount, to whom and reason *List separately each item amounting to 10 per cent or more of the total and combine the reminder. 10 DETAILS RELATIVE TO ASSETS Continued 5* Accounts receivable not from construction contracts $ 38,223 RECEIVABLE FROM: NAME AND ADDRESS IFOR WHAT WHEN DUE AMOUNT Misc. Employees/other I Advances/Other $ 38.223 What amount if any is past due s0 6 Deposits with bids or otherwise as guarantees_ 0 DEPOSITED WITH: NAME AND ADDRESS I FOR WHAT WHEN RECOVERABLE AMOUNT 7 Interest accrued on loans, securities etc. $ 0 8 Real estate (a) Used for business purposes $88 427,413 Book value (b) Not used for business purposes DESCRIPTION OF PROPERTY IMPROVEMENTS TOTAL BOOK VALUE NATURE OF IMPROVEMENTS BOOK VALUE 1 Land 4,370,387 2 Buildings & Land Improvements 4,057,026 3 4 5 6 7 LOCATIONI HELD IN WHOSE NAME I ASSESSED VALUE AMOUNT OF ENCUMBRANCES *List separately each item amounting to 10 per cent or more of the total and combine the reminder. 11 9 AGE OF ITEMS Stocks and Bonds: (a) Listed -present market value (b) Unlisted -present value $_ 0. $ 0. BOOK VALUE DESCRIPTION ISSUING COMPANY LAST INT. OR DIV. PAID DATE % PAR VALUE PRESENT MARKET VALUE QUANTITY AMOUNT 1 None Construction Equipment Various 32,421,201 17,414,746 2 Trucks & Trailers Various 14,729,962 7,758,560 3 Shop, Lab & Radio Equipment Various 618,267 503,431 4 5 6 7 WHO HAS POSSESSION IF ANY ARE PLEDGED OR IN ESCROW, STATE FOR WHOM AN D REASON AMOUNT PLEDGED OR IN ESCROW 1 2 3 4 5 6 7 Materials in stock and not included in Item 4, Assets: 10 (a) For use on uncompleted contracts (present value) X5115,421 (b) Other materials (present value). DESCRIPTION OF MATERIAL QUANTITY PRESENT VALUE FOR UNCOMPLETED OTHER CONTRACTS MATERIALS Liquid Asphalt 16,657 Fuel oil 25.663 Aggregates 4,480,251 Plant Mix and other inventory 275,576 Recycled Materials 417.274 11 * Equipment at book value ULLO§110 QUANT DESCRIPTION AND CAPACITY OF TTY ITEMS AGE OF ITEMS PURCHASE PRICE DEPRECIATION CHARGED OFF BOOK VALUE Plant Equipment Various 25,155,174 15,441,302 9,713,872 Construction Equipment Various 32,421,201 17,414,746 15,006,455 Trucks & Trailers Various 14,729,962 7,758,560 6,971,402 Shop, Lab & Radio Equipment Various 618,267 503,431 114,836 Are there any liens against the above? No Is so, state total amount T $ 0 *If two or more items are lumped above, give the sum of their ages. 12 DETAILS RELATIVE TO ASSETS 12 Furniture and fixtures at book value $ 411,235 13 Other assets $ 4,932,130 DESCRIPTION AMOUNT Construction in progress 999,561 Prepaid ex enses & other assets, including intangibles 2,914,124 Costs & Earninps in Excess of Billings 1.018.445 TOTAL ASSETS $ 89,359,005 j DETAILS RELATIVE TO LIABILITIES Payable: 1 Notes (a) To banks, regular $ 3,000,000 (b) To banks, for certified checks $ 0 (c) To others for equipment obligations $ 12,332,898 (d) To others exclusive of equipment obligations $ 0 TO WHOM: NAME AND ADDRESS WHAT SECURITY WHEN DUE AMOUNT Centier Bank 3.000.000 Various 2 Accounts payable: (a) Not past due $ 4,479,803 (b) Past due $ 0 TO WHOM: NAME AND ADDRESS FOR WHAT DATE PAYABLE AMOUNT Various Materials 2,638,499 Subcontractors 1,841,304 Deferred Compensation 6,274,516 Accrued Proparty Taxes 541,445 3 1 Real estate encumbrances (See Item 8, Assets) $ 0.00 4 Other liabilities _ $ 11,636,485 DESCRIPTION AMOUNT Accrued Wages/Taxes 3,670 507 Billings in excess of Costs and Estimated Earnings 576,778 Deferred Compensation 6,274,516 Accrued Proparty Taxes 541,445 Other Current Liabilities 573,239 5 1 Reserves S 0 INTEREST INSURANCE BLDG. & FIXT. PLANT DEPR. TAXES BAD DEBTS $ $ $ $ $ $ $ $ 6 Capital stock paid up: (a) Common $ 10,000 (b) Preferred $ 0 7 Surplus $ 57.899,819 TOTAL LIABILITIES $89,359,005 13 If a corporation answer this: Amount for which incorporated Capital paid in When incorporated 1966 In What State Indiana 11 Names and titles of all persons having authority to execute and receipt estimate vouchers and to conduct other business for the corporation, including its officers, the signatures of whom are legally binding. Todd A. Fawver, President Jamie L. Tancos, Secretary/Treasurer John M. Peisker, Vice President -Production David J. K2Ma, VP -Area Manager Griffith Lynn J. Bauer, VP -Area Manager South Bend Gregory A. Hoffrnan, Dir. of Estimating Griffith Dustin P. Hilary, Dir. of Estimating South Bend Mark E. Krachenfels, Construction Manager Do you have necessary "certificate of authority" to transact corporate business in this state, under the terms of Chapter 215, Acts of 1929, and acts amendatory thereto? If a co -partnership answer this: Date of organization Yes State whether co -partnership is general, limited or association Give the names, addresses and proportional interest of all parties: Name Address Share ...... ..._..... __................ .. ............ ..----_ _ _..._. $ S _.._...... ..... .- ...... The name of the partnership firm under which the above partners are operating is Give names and titles of all persons having authority to execute and receipt estimate vouchers and to conduct other business for the partnership, the signatures of whom are legally binding. 14 The undersigned hereby declares that the foregoing is a true statement of the financial c dition of the individual, co -partnership or corporation herein first named, as of the date herein first given; that this statement is for thx ess pu ose of inducing the party to whom it is submitted to award the submittor a contract; and that any depository, vendor T th agency ein named is hereby authorized to supply such party with any information necessary to verify this statement. NOTE: A co -partnership must give firm name and signatures of all partners. A corporation must give full corporate name, signature of official and affix corporate seal. ustin P. Hilarv, Director of Estimating. South Bend Affidavit for Individual STATE OF 2 r '• i COUNTY OF ss: 0 :: `OR4 0 RA iE ; S being duly sworn, d$s an 3�' t th� foregoing financial statement, taken from his books, is a true and accurate statement of his financial condition3s $Xh f.'and- that the answers to the foregoing interrogatories are true. (Applicant must sign here)�I�lll��` Subscribed and sworn to before me this day of 20 Notary Public Affidavit for Co -Partnership STATE OF COUNTY OF ss being duly sworn, deposes and says that he is a member of the firm of ; that he is familiar with the books of the said firm showing its financial condition; that the foregoing financial statement, taken from the books of the said firm , is a true and accurate statement of the financial condition of the said firm as of the date thereof and that the answers to the foregoing interrogatories are true. (Member of firm must sign here) Subscribed and sworn to before me this day of 20 Notary Public Affidavit for Corporation STATE OF Indiana COUNTY OF _Lake { ss GrepOry A. Hoffman being duly sworn, deposes and says that he is Director of Estimating_of the Milestone Contractors North, Inc. the corporation described in and which executed the foregoing statement; that he is familiar with the books of the said corporation showing its financial condition; that the foregoing financials ent, from the books of the said corporation, is a true and accurate statement of the financial condition of said corporation as o date rf and that the answers to the foregoing interrogatories are true. Subscribed and sworn to before me this 8u' daviof June 2021. Alisha rueger, Notary Public SR Y o 15 must sigk5ere) Dustin P. Hilary, Director of Estimating, South Bend �%tracto s��i�i� •o . .. ; LO c" CU �•� :3 .,SEAL/-n lllllll11 ALISHA KRUEGER NOT = LaPorte County My Commission Expires oF'• June 5, 2022 15 must sigk5ere) Dustin P. Hilary, Director of Estimating, South Bend �%tracto s��i�i� •o . .. ; LO c" CU �•� :3 .,SEAL/-n lllllll11 State of Indiana Office of the Secretary of State CERTIFICATE OF EXISTENCE To Whom These Presents Come, Greeting: I, HOLLI SULLIVAN, Secretary of State of Indiana, do hereby certify that I am, by virtue of the laws of the State of Indiana, the custodian of the corporate records and the proper official to execute this certificate. I further certify that records of this office disclose that MILESTONE CONTRACTORS NORTH, INC. duly filed the requisite documents to commence business activities under the laws of the State of Indiana on March 29, 1966, and was in existence or authorized to transact business in the State of Indiana on May 24, 2021. 1 further certify this Domestic For -Profit Corporation has filed its most recent report required by Indiana law with the Secretary of State, or is not yet required to file such report, and that no notice of withdrawal, dissolution, or expiration has been filed or taken place. All fees, taxes, interest, and penalties owed to Indiana by the domestic or foreign entity and collected by the Secretary of State have been paid. ��•••STA%��`• In Witness Whereof, I have caused to be affixed my signature and the seal of the State of Indiana, at the City Q� tam of Indianapolis, May 24, 2021 •� - HOLLI SULLIVAN N8�8 SECRETARY OF STATE 194484-057 20212030754 All certificates should be validated here: https.-Hbsd.sos.in.gov/ValidateCertificate Expires on lune 23, 2021. State of Indiana Office of the Secretary of State Certificate of Amendment of WALSH & KELLY INC I, CONNIE LAWSON, Secretary of State, hereby certify that Articles of Amendment of the above Domestic For -Profit Corporation have been presented to me at my office, accompanied by the fees prescribed by law and that the documentation presented conforms to law as prescribed by the provisions of the Indiana Code. The name following said transaction will be: MILESTONE CONTRACTORS NORTH, INC. NOW, THEREFORE, with this document I certify that said transaction will become effective Monday, February 01, 2021, In Witness Whereof, I have caused to be affixed my signature and the seal of the State of Indiana, at the City of Indianapolis, February 01, 2021 CONNIE LAWSON SECRETARY OF STATE 194484-057 / 8878219 To ensure the certificate's validity, go to https://bsd.sos,in.gov/PubiicBLISinessSearch State of Indiana Office of the Secretary of State Certificate of Assumed Business Name of MILESTONE CONTRACTORS NORTH, INC. I, CONNIE LAWSON, Secretary of State, hereby certify that a Certificate of Assumed Business Name of the above Domestic For -Profit Corporation has been presented to me at my office, accompanied by the fees prescribed by law and that the documentation presented conforms to law as prescribed by the provisions of the Indiana Code. Following said transaction, the above named entity will transact business under the assumed business name(s) of: WALSH & KELLY NOW, THEREFORE, with this document I certify that said transaction will become effective Monday, February 01, 2021. I 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. R S t CQt4Nlt LAWSOU SECUTAM Of STATE 19448.4 057 1 8878234 To ensure the rerlificate's validity, go to https7//bsd soy in gov/PublicGusinessSearch V,.iF' Request for Taxpayer FormGive Form to the (Rev. October 2.018) Identification Number and Certlftcation requester. Dont tnlemal Ra Serv6oe 1 Go to wwwJro.gov/AOMWP for Instructions and the latest Information. send to the IRS. 1 Name (as shown on your Income tax return* Nam], nqu(red On this ane; do not isave tints nne blanc. +MILESTONE CONTRACTORS NORTH, INC. 2 Buslnesa neme/disregardod "ty arms, if dltfertnt from above WALSH & KELLY, INC. 3 Chock appropriate box for federal tax dation of the person whose name is entered on line 1. Check only one of the a Exemptions (codes apply only to following smeven boxes. oenaln entities, not individuals; see c ❑ trmrt+vsduavaob Ifp tractions on pegs 3}: proprietor or EJC Corporation O p ❑ 7nrat/eatete S Corporation ❑ Partnermi shgb-rrmember LLC E:x.mpt payee code (H any) ❑ United fiabinty company. Enter the tax classification (CwC oorporatlon, S.S oorporatlon, P6Partnership) P Zj Note. Check the appropriate box in the line abm for the tax Classification of the single -member owner. DO not check Exemption from FATCA ropordnp LLC H the LLC Is classified as a sfngla- member LLC that is disregarded from the owner uMees tiro owner of the LLC is code Gl arty) u anotherwner LLC that is not disregarded from the ofor U.S. feden d tax purposes. Otherwise. a "I*-membar LLC that to d-eregarded from the owner 4hould check the appropriate box for the tax classification of its owner. ❑ Other fees lnstntotione) ► - 1Wr+ak a.r�u+r. nrr a.t.eowrae r,e use 6 Address (number, straet, and W. or suite raj See instructions. Paqueetses name and address (optional) 1700 EAST MAIN STREET 6 City, state, and ZIP code GRIFFITH, IN 46319 T List account number(s) snare • Taxpayer identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on fine 1 to avoid Sociat eeantty number _ backup withholding. For Individuals, is this b dgenerallyentity, your social security number , late . However, for a resident alien, isole proprietor, or disregarded entity, see the Instructions for Part 1, later. For other entitiers, It Is your employer ldentffication number (EIN). If you do not have a nurnW, see Now to yet a 77N, later. or Note: If the account is in more than one name, see the instructions for Una 1. Also see What !Name and [ Employsr Identification number Number To Give the Requester for guidelines on whose number to enter. - 3 5 1l1 2 0 68 5 E;x�P�1��, _ -- Certifit;al;aon Under penalties o1 perjcwy, I certify that: 1. The number shown on this form Is my correct taxpayer Identification number (or I am waking for a number to be issued to me): and 2.1 am not subject. to backup withholding because: (a) I am exempt from backup wkhtmolding, or (b) I have not been notified by the Internal Revenue Service ORS) that I am subject to backup withholding as a result of a failure to report all itnenset or d'Mdends, 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 an this form of any) indicating that I am exempt from FATCA reporting is oorrect. Ceitfficatlon hetructiona, You must dross out item 2 above if you have been ratified 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, cartoelWon of debt, contributions to an individual retirement arrangement ORA), anis generally, payments other then 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. Here U-Uxrf of S. p. on 1 t j i i lit 0-1 J-4,11(f..a •►t l i Ck _ Dot* 1 R � Z z .( General instructions Section references are to the lntemal Revenue Coda unless otherwise noted. Future developmants. For the latest Information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.lrs.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 obtdn your correct taxpayer identification number {TIN) which may be your social security number (SSM, individual taxpayer identification number OTIN), adoption taxpayer identification number (AT1N), or employer identification number (EIM, to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099 -INT (interest earned or paid) a Form 1099-b1V (dividends, Including those from stocks or mutual funds) • Form 1099 -MSC (varfous types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sates and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098•E (student loan Interest), 1098-T (tuition) • Form 1099-C (Canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. parson (including a resident alien), to provide your correct TIN. M you do not return Form W-9 to the requester with a nN, you might be subject to backup withholding. See What is backup withholding, later. Gat. No. 1D231x ��`-- Form W-9 ftv,10-201E) 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 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 8r Curbing 1611.02 Asphalt Construction of Roads and Parking Lots CERTIFICATION DATE 1114/2020 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. Crass, Exkktive Secretary Certification Board DAPW PQ2 State Form 3983R Rev. 07106 WRITTEN CONSENT TO RESOLUTIONS of the BOARD OF DIRECTORS of WALSH &KELLY, INC. The undersigned, being all of the members of the Board of Directors (the "Board") of Walsh & Kelly, Inc. ("Company"), hereby consent to the following Resolutions in lieu of a special meeting of the the Board: WHEREAS, The Board believes that it is in the best interest of the Company to amend the Articles of Incorporation to change the name of the Company to Milestone Contractors Nortk, Inc. ("Name Change"); NOW, THEREFORE, BE IT RESOLVED, that the Board recommends the filing of the Articles of Amendment to the Articles of Incorporation; FURTHER RESOLVED, that the Board and/or any officer of the Company, signing singly, are hereby authorized and directed to file the Articles of Amendment to the Articles of Incorporation with the Indiana Secretary of State and to execute and deliver any such additional documents, assignments, instruments and agreements and to take such further actions as may be deemed necessary or appropriate in connection with the Name Change. RESOLVED, FURTHER, that the Board and/or any officer of the Company, signing singly, is, hereby authorized and directed to take any and all additional steps and actions which are necessary and advisable in order to carry out the intent and purpose of the foregoing resolutions; and RESOLVED, FURTHER, that this Consent may be executed in one or more counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same Consent, and any facsimile or electronic transmission of a signed counterpart shall be deemed to be an original counterpart and any signature _- appearing thereon shall be deemed to be an original signature. Signature Page Follows �igr�gl. �qge to..EF!ritten _Cnnseut Dated effective as of the 1st day of February, 2021 k' 1 Fred Fehse4eld, Jr. gh .ar 26, 2021202 on Albert E. VanDenBergh Geoffrey C. Dillon James C. Fehsenfeld John P. Vercruysse WRITTEN CONSENT TO RESOLUTIONS of the BOARD OF DIRECTORS of MILESTONE CONTRACTORS NORTH, INC. The undersigned, being all of the Directors of MILESTONE CONTRACTORS NORTH, 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 ofthe Board of Directors and until their successors are duly elected and have qualified: Todd A. Fawver Charles Potts Jr. John P. Vercruysse Jamie L. Tancos Albert E.VanDenBergh David L. Franz John M. Peisker Patrick J. Walters Brad McCall Derek Merida Lynn J. Bauer David M. Kozyra Mark Andrews President Chief Operating Officer, Construction Executive Vice President Vice President, Secretary & Treasurer Vice President Vice President Vice President, Production Vice President, Finance Vice President, Estimating Vice President, Bridge Operations Vice President/Area Manager, South Bend Vice President/Area Manager, Griffith Executive Vice President RESOLVED FURTHER that the above officers be, and they hereby are, authorized to execute all contracts or similar documents on behalf of the Corporation. In addition to the above officers the following are hereby appointed as authorized signers on behalf of the Corporation: David J. Misirly Senior Estimator Gregory A. Hoffman Director of Estimating, Griffith Dustin P. Hilary Director of Estimating, South Bend Mark E. Krachenfels Construction Manager 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 this consent shall be in lieu of an annual meeting of the Board of Directors of the Corporation and shall be filed in the minute book of the Corporation in place of any such annual minutes. �- «SIGNATURES CSN' F1X—NEXT'PAGE»- EXECUTED this 2"d day of February, 2021. Fred Fel senfeld, Jr. ,4L62e Be�Al2 Albert E VanDenBerRh (Mar26.2021 2&2MII Albert E. VanDenBergh Geoffrey C. Dillon h James C. Fe senfeld John P. Vercruysse Pii� Milestone EQUAL EMPLOYMENT OPPORTUNITY/ AFFIRMATIVE ACTION POLICY STATEMENT It is the policy of Milestone Contractors to afford equal opportunity for employment to all individuals regardless of race, color; religion, sex, sexual orientation, gender identity, national origin, age, disability, housing status, or veterans' status. The corporation is committed to this policy by our status as a federally assisted government contractor. We are far more strongly bound to the policy by the fact that adherence to the principles involved is the only acceptable American way of life. Therefore, it is the policy of this corporation to assure that applicants are employed, and that employees are treated during employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, housing status, or veterans' status. Such action shall include: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship, pre - apprenticeship, and/or on-the-job training. The successful achievement of a nondiscriminatory employment program requires a maximum of cooperation between management and employees. In fulfilling its' part in this cooperative effort, management is obliged to lead the way by establishing and implementing affirmative procedures and practices which will ensure our objective, namely equitable employment opportunity for all. (Minority and female employees are encouraged to participate in all company activities and refer applicants.) I have designated Margaret Garner to direct the establishment of and to monitor the implementation of personnel procedures to guide our affirmative action program. This official is charged with designing and implementing audit and reporting systems that will keep management informed on a regular basis of the status of equal employment opportunity and affirmative action. She can be reached at (317)616-4937. Supervision has been made to understand that their work performance is being evaluated based on their equal employment opportunity efforts and results, as well as other criteria. It shall be a responsibility of the supervision to take actions to prevent harassment of employees placed through affirmative action efforts. We shall comply with the Civic Rights Act of 1964, as amended, the Federal Highway Act of 1968, the Executive Order #11246 and #11375, the Rehabilitation Act of 1973, as amended, the Vietnam Era Veterans Readjustment Assistance Act of 1974, as amended, the Indiana Civil Rights Act and other applicable Federal and State Laws and regulations pertaining to equality of Opportunities and Affirmative Action policies. We have developed an Affirmative Action Program for Veterans and Individuals with Disabilities. CJ Po s, Chief Operating Officer Margaret Garner, HR Area Partner/EEO Officer February 2021 Fii\ 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 mgarnerPmilestonelp.com (317)616-4937 61116�- CJ Potts, Chief Operating Officer (gertiflumte of Qualtrwatian INDIANAPOLIS, IN TO MILESTONE CONTRACTORS NORTH, INC. May 20, 2021 GRIFFITH, IN who has tiled with the Department a Coniractoes Statemert of Experience and Financial Condition as required under Indiana Code 8-23-10, Is hereby qualified io bid at any Department of Transportation letting in gasses 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 exosed the Aggregate amount Classification references by name or symbol are in accordance with the definitions in the Cortn3does Statementof Experience and Financial Condition. This certificate supersedes any certificate previously issued, but is subject to revision or revocation according to the law, it and when changes in the financial condition cf the cointrac ting firm or other facts justly such revision or revocation. Valid May 19, 2021 Thru September 30, 2022 Aggregate Bidding Capacity: 552,167,000.1 A(B) CONCRETE PAVEMENT: LIMITED................................................................................... $25,000,000.00 B(A) ASPHALT PAVEMENT: W/INDOT CERTIFIED HMA PLANT ............................................. $99,999,999.00 C(B) LIGHT GRADING............................................................................................................... $99,999,999.00 E(E) SMALL STRUCTURES AND DRAINAGE ITEMS.............................................................. $25,000,000.00 E(F) SURFACE MASONRY AND MISCELLANEOUS CONCRETE ........................................... $50,000,000.00 E(G) TRAFFIC CONTROL: PAVEMENT MARKINGS................................................................ $25,000,000.00 E(H) DEEP SEWER AND/OR EXCAVATION.............................................................................. $25,000,000.00 E(Q) CONCRETE PAVEMENT: REPAIRS.................................................................................. $25,000,000.00 E(R) ASPHALT PAVEMENT MILLING....................................................................................... $50,000,000.00 PRE-aUALIPICATION ENGINEER Sesta forni 2OWS jfO i SwF COMMISMNER PREQUALIFICATION WORKSHEET PRINTED: 05/20/2021 ACCOUNT M 351120685 VALID: 05/19/2021 NAME: Milestone Contractors North, Inc. EXPIRES: 09/30/2022 APPLICATION TYPE: New AUDITOR APPROVED: 0511212021 FINANCIAL STATEMENT TYPE: Audit ANALYST APPROVED: 05/19/2021 FINANCIAL STATEMENT DATE: 12/31/2020 PREQUALIFICATION APPROVED: 05/20/2021 ASSETS REPORTED LIABILITIES REPORTED -- -- --- ----------------- NET ASSETS REPORTED NET FIXED ASSETS NET FIXED ASSETS EQUIPMENT NET ACCEPTABLE ASSETS CURRENT FIXEDEQUIPMENT --- ------------- $45,301,075.00 $11,290,806.00 $32,767,124.00 $15,307,087.00 $16,142,099.00 ................ ---------------- ---------------- $29,993,988.00 $(4,851,293.00) $32,767,124.00 $0.00 $0.00 ---------------- ----- ------------ -------- — - -- $27,948,981.00 $5,270,157.00 $32,767,124.00 RATING FACTORS X10 X 2 X 8 ----------------------------------------------------------- RATING COMPONENTS $279,489,810.00 $10,540,314.00 $262,136,992.00 x 1.5 - $262,136,992.00 - ---------------- MAXIMUM EQUIPMENT $419,234,715.00 $0.00 8 $262,136,992.00 $0.00 + $279,489,810.00 + $5,270,157.00 ------------------ -------------------- $541,626,802.00 $5,270,157.00 X 0.25 X 2 -------------- ------ ------------------ MAXIMUM FIXED $135,406,701.00 ADJUSTED FIX. $10,540,314.00 ----------------- BALANCE SHEET ANALYSIS COMPONENT RATING CURRENT $279,489,810.00 FIXED $10,540,314.00 EQUIPMENT --------------- $262,136,992.00 -- MAXIMUM BALANCE ----------------- $552,167,116.00 STATEMENT TYPE Audit EXPER. REDUCTION 0.00% AGG. BIDDING CAPACITY $552,167,000.00 CURRENTASSETS:$45,301,075.00 ------------ ................ CURRENT RATIO: 2.96 INVENTORY: --------- $5,215,421.00 ------ —------------ QUICK RATIO: ---------- — --- ---- 2.62 CURRENT LIABILITIES: --- ------------------- $15,307,087.00 ------------------ -- -------------------- WORKING CAPITAL: ---- — - ------- $29,993,988.00 LONG TERM LIABILITIES: ---------------------- - $16,142,099.00 ------.------- ------------------------------------------ DEBIT/ NET WORTH: 0.54 NET WORTH: - ----------------- - $57,909,819.00 --------------- ------------------------- --------- ACCOUNTS RECEIVABLE TURNOVER: ------------------------------------- ------------------ 8.63 TOTAL LIABILITIES: ---------------- $31,449,186.00 -- —------- ACCOUNTS RECEIVABLE/TOTAL CURRENTASSETS: --------- ---- -------------------------------------- ------ 0.38 ACCOUNTS PAYABLE/TOTAL CURRENT LIABILITIES: ------------------------------------------------ - 0.30 --_-----_.------- ._. - RECEIVABLES/PAYABLES:3.74 DAYS IN ACCOUNTS RECEIVABLE: 42.27 ADJUSTMENTS Line Item # - Description Current Adjustment Amount Fixed Equipment 11 Detail is not Clear $(38,221.00) $0.00 $0.00 16 Omit Goodwill $0.00 $(1,138,640.00) $0.00 17 Due after 24 Months $0.00 $12,033,636.00 $0.00 99 Omit Affiliates $(2,780,332.00) 99 Reclassify to Current $1,274,516.00 $(1,274,516.00) 99 To 16 Long Term $(500,970.00) $500,970.00 Page 1 of 2 ACCOUNT #: 351120685 NAME: Milestone Contractors North, Inc. APPLICATION TYPE: New FINANCIAL STATEMENT TYPE: Audit FINANCIAL STATEMENT DATE: 12/31/2020 WORK TYPES Code Description Approved Amount A(b) CONCRETE PAVEMENT: LIMITED $25,000,000.00 B(a) ASPHALT PAVEMENT: W/INDOT CERTIFIED HMA PLANT $99,999,999.00 C(b) LIGHT GRADING $99,999,999.00 E(e) SMALL STRUCTURES AND DRAINAGE ITEMS $25,000,000.00 E(f) SURFACE MASONRYAND MISCELLANEOUS CONCRETE $50,000,000.00 E(q) TRAFFIC CONTROL: PAVEMENT MARKINGS $25,000,000.00 E(h) DEEP SEWER AND/OR EXCAVATION $25,000,000.00 E(q) CONCRETE PAVEMENT: REPAIRS $25,000,000.00 E(r) ASPHALT PAVEMENT MILLING $50,000,000.00 VALID: 05/19/2021 EXPIRES: 09/30/2022 AUDITOR APPROVED: 05/12/2021 ANALYST APPROVED: 05/19/2021 PREQUALIFICATION APPROVED: 05/20/2021 Page 2 of 2