HomeMy WebLinkAboutOpening of Bids - Roadway Reconstruction Proj No. 121-008 - 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
Roadway Reconstruction
121-008
June 8, 2021
From time to time the South Bend Board of Public Works finds it necessary to reject a bid because
it does not comply with statutory requirements. In preparing your bid, please use the following
checklist in order to make sure that your bid is done in the proper manner.
Proper bid security included. The bidder has the option of providing either a Certified Check
X or Bid Bond.
Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely
X executed.
Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments
with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and
X Certification of use of United States Steel Products or Foundry Products.
Proof of MWBE Utilization Plan [MWBE-1.0]. If minimum participation goal is not met, also
provide Evidence of Good Faith Efforts Form [MWBE-2.0] and MWBE Contacted Form
X [MWBE-2.1].
X Acknowledge Receipt of 1 Addendum(s) included with the bid.
X All required additional information is included with the bid.
Proposal statements and other affidavits all signed by the proper party with name either
X printed or typed underneath signature.
X This checklist submitted with the Bid.
This checklist is provided for bidder's use in assuring compliance with required
documentation; however, it does not include all specifications requirements and does not
relieve the bidder of the need to read and comply with the specifications.
Bidder: Milestone Contractors, rth, Inc. Date: 6/8/2021
By Authorized Representaiiv/.
Signature:
Print Name & Title: ;Zustin P. Hilary, Director of Estimating, South Bend
Version 01/13/2021 Contractor's Bid for Public Works - 1
Date
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
Project Name
Project No.
For Bids Due
Roadway Reconstruction
121-008
June 8, 2021
PART I
(Must be completed for all bids. Please type or print)
6/8/2021 Bidder (Firm): Milestone Contractors North. Inc.
Address: 24358 SR 23
City/State/Zip: South Bend, IN 46614 Telephone Number: ( 574 ) 288-4811
Agent of Bidder (if Applicable):
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the
public works project of:
Roadway Reconstruction
the City of South Bend, Indiana, in accordance with plans and specifications prepared by:
Hanson Professional Services, Inc.
and dated 5/12/2021 for the sum of (enter the Total Bid as shown on the Proposal)
Two million three hundred ninety eight thousand dollars and zero cents ($ 2,398,000.00
?
(Enter sum of Total Base Bid plus Alternates shown on Proposal) (Numerical)
The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in
the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance
with the notice. Any addendums attached will be specificsV referenced at the applicable page.
If additional units of material included in the contract ar ede the cost of units must be the same as that
shown in the original contract if accepted by the C' SoL Bend. If the bid is to be awarded on a unit
basis, the itemization of the units shall be show n sep 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
Murray L. Miller, Member
fes' (Signature)
tustin P. Hilary, Director of Estimating, South
(Printed Name of Person Signing)
ACCEPTANCE
day of
Joseph R. Molnar, Member
Jordan V. Gathers, Member
Attest: Anne Fuchs, Clerk
Version 01/13/2021 Contractor's Bid for Public Works - 2
20
PART II
(For projects of $100,000 or more — IC 36-1-12-4)
These statements to be submitted under oath by each bidder with and as part of his/her/its bid.
Attach additional pages for each section as needed.
SECTION I EXPERIENCE QUESTIONNAIRE
1. Attach information regarding projects your organization has completed for the period of one
(1) year prior to the date of the current bid.
2. Attach a listing of public works projects currently in process of construction by your
organization.
3. Attach information regarding any failure to complete any work awarded to you and the
location thereof.
4. Attach references from private firms for which you have performed work.
SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE
1. Attach an explanation of your plan or layout for performing proposed work. (Examples could
include a narrative of when you could begin work, complete the project, number of workers,
etc. and any other information which you believe would enable the City of South Bend to
consider your bid.)
2. Attach a listing of the names and addresses of all subcontractors (i.e. persons or firms outside
your own firm who have performed part of the work) that you have used on public works
projects during the past five (5) years along with a brief description of the work done by each
subcontractor.
3. If you intend to sublet any portion of the work, attach the name and address of each
subcontractor, equipment to be used by the subcontractor, and whether you will require a
bond. However, if you are unable to currently provide a listing, please understand a listing
must be provided prior to contract approval. Until the completion of the proposed project, you
are under a continuing obligation to immediately notify the City of South Bend in the event that
you subsequently determine that you will use a subcontractor on the proposed project.
4. Attach a listing of equipment you have available to use for the proposed project.
5. Have you entered into contracts or received offers for all materials which substantiate the
prices used in preparing your proposal? If not, attach an explanation for the rationale used
which would corroborate the prices listed.
SECTION III CONTRACTOR'S FINANCIAL STATEMENT
Attachment of bidder's financial statement is mandatory. Any bid submitted without said
financial statement as required by statute shall thereby be rendered invalid. The financial
statement provided hereunder to the City of South Bend awarding the contract must be specific
enough in detail so that said City of South Bend can make a proper determination of the bidder's
capability for completing the project if awarded.
Version 01/13/2021 Contractor's Bid for Public Works - 3
When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit.
CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION
REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON-
DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL
PRODUCTS OR FOUNDRY PRODUCTS
(Must be completed for all quotes and bids. Please type or print)
STATE OF Indiana )
) SS:
St. Joseph COUNTY )
The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury
that:
1. Contractor has not, nor has any other member, representative, or agent of the firm, company,
corporation or partnership represented by him, entered into any combination, collusion or agreement with
any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding
nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and
without any agreement, understanding or combination with any other person in reference to such bidding.
Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or
indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and
2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals
are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
participation in this transaction by any Federal department or agency; and
3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in
investment activities in Iran.
a. For purposes of this Certification, "Iran" means the government of Iran and any agency
or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as
amended from time -to -time.
b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor
is engaged in investment activities in Iran if either:
i. Contractor, its successor or its affiliate, provides goods or services of twenty
million dollars ($20,000,000) or more in value in the energy sector of Iran;
or
ii. Contractor, its successor or its affiliate, is a financial institution that extends
twenty million dollars ($20,000,000) or more in credit to another person for
forty-five (45) days or more, if that person will (i) use the credit to provides
goods and services in the energy sector in Iran; and (ii) at the time the
financial institution extends credit, is a person identified on list published by
the Indiana Department of Administration.
Version 01/13/2021 Contractor's Bid for Public Works - 4
4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any
employee or contract with a person that the Contractor subsequently learns is an unauthorized alien.
Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of Contractor's
newly hired employees through the E -Verify Program as defined by I.C. 22-5-1.7-3. Contractor's
documentation of enrollment and participation in the E -Verify Program is included and attached as part of
this bid/quote; and
5. Contractor shall require his/her/its subcontractors performing work under this public contract to
certify that the subcontractors do not knowingly employ or contract with an unauthorized alien, nor retain
any employee or contract with a person that the subcontractor subsequently learns is an unauthorized alien,
and that the subcontractor has enrolled in and is participating in the E -Verify Program. The Contractor agrees
to maintain this certification throughout the term of the contract with the City of South Bend, and understands
that the City may terminate the contract for default if the Contractor fails to cure a breach of this provision
no later than thirty (30) days after being notified by the City.
6. Persons, firms, partnerships, corporations, associations, or joint venturers awarded a contract by the
City of South Bend through its agencies, boards, or commissions shall not discriminate against any employee
or applicant for employment in the performance of a City contract with respect to hire, tenure, terms,
conditions, or privileges of employment, or any matter directly or indirectly related to employment because
of race, sex, religion, color, national origin, ancestry, age, gender expression, gender identity, sexual
orientation or disability that does not affect that person's ability to perform the work.
In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials, or any
combination of the foregoing including, but not limited to, public works contracts awarded under public
bidding laws or other contracts in which public bids are not required by law, the City, its agencies, boards,
or commissions will consider the Contractor's good faith efforts to obtain participation by those
subcontractors certified by the State of Indiana as a Minority Business ("MBE") or as a Women's Business
Enterprise ("WBE") as a factor in determining the lowest, responsible, responsive bidder.
Contractors seeking the award of a City contract cannot be required to award a subcontract to an-MWBE;
however, they may not unlawfully discriminate against said MBE/WBE. A finding of noncompliance or a
discriminatory practice shall prohibit that Contractor from being awarded a City contract for a period of one
(1) year from the date of such determination, and such determination may also be grounds for terminating
the contact to which the discriminatory practice or noncompliance pertains.
7. The undersigned Contractor agrees that the following nondiscrimination commitment shall be made
a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its
agencies, boards or commissions.
Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the
performance of this contract with privileges of employment, or any matter directly or indirectly related to
employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation,
handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of
contract.
I, the undersigned bidder or agent as contractor on a public works project, understand my statutory
obligations to the use of steel products or foundry products made in the United States (I.C. 5-16-8-1). I hereby
certify that I and all subcontractors employed by me for this project will use steel products or foundry
products made in the United States on this project if awarded. I understand I have an affirmative duty to
notify the City in my bid that my proposal does not include the use of steel products or foundry products
made in the United States. I understand it is my sole obligation and responsibility to provide a justification
to the City, subject to review and approval, why the cost of United States made steel or foundry products is
unreasonable. Prior to award and upon submission of bid which does not use steel products or foundry
products made in the United States, the City, through its director of public works, shall make a determination
if the price of United States made steel or foundry is unreasonable. I understand that violations hereunder
may result in forfeiture of contractual payments.
Version 01/13/2021 Contractor's Bid for Public Works - 5
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 , 20 21
`� 1tCactOrs �I
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Subscribed and sworn to before me this
My Commission Expires 6/5/22
of Contractor/Bidder or Its Agent
'Dustin P. Hilary, Director of Estimating, South Bend
Printed Name and Title
8th day of June , 2021
Notary 1`561k Alish tKrueger
County of Residence
LaPorte
Version 01/13/2021 Contractor's Bid for Public Works - 6
�p� •.,
ALISHAKRUEGER
La Porte County
ryCTAr'Y
My Commission Expires
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June 5 2022
Version 01/13/2021 Contractor's Bid for Public Works - 6
BID/PROPOSAL
CITY OF SOUTH BEND s�uarr�,
PROJECT NAME:�.r71
Roadway Reconstruction
PROJECT NO. 121-008
FOR BIDS DUE: June 8, 2021
CONTRACTOR NAME: Milestone Contractors North. Inc.
BASE BID
Item
DescriptionNQ
Quantity
Unit
Unit Price
Total Amount
1
Maintenance of Traffic
1
LS
78,000.00
$78,000.00
2
Construction Engineering
1
LS
22,600.00
$22,600.00
3
Mobilization & Demobilization
1
LS
173,200.00
$173,200.00
4
Clearing ROW
1
LS
51,984.49
$51,984.49
5
Pavement Removal
3051
SYS
10.00
$30,510.00
6
Curb Remove, All Types
4025
LFT
6.00
$24,150.00
7
Concrete Approaches & Sidewalk, Remove
3072
SYS
7.00
$21,504.00
8
Inlet Remove
4
EACH
800.00
$3,200.00
9
Railing, Remove
110
LFT
22.00
$2,420.00
10
Fence Chain Link, Remove
135
LFT
E11
22.00
$2,970.00
Fence, Farm Field, Remove
53
LFT
22.00
$1,166.00
12
Excavation, Common
2091
CYS
67.00
$140,097.00
13
B Borrow
471
CYS
22.00
$10,362.00
14
Stormwater Management Budget
22355
DOL
1.00
$22,355.00
15
Stormwater Management Implementation
1
LS
5,750.00
$5,750.00
16
SWQCP Preparation
1
LS
6,500.00
$6,500.00
17
Subgrade Treatment Type II
9029
SYS
15.00
$135,435.00
18
Compacted Aggregate No. 53
2780
TON
26.00
$72,280.00
19
Compacted Aggregate No. 53, Temporary for
70
TON
Driveways
8.00
$560.00
20
HMA Patching, Full Depth, Type B
2028
TON
120.00
$243,360.00
21
Milling, 3 IN.
12446
5.00
$62,230.00
22
Milling, 4 IN.
348
20.00
$6,960.00
23
Milling, Approach
544
qTON
20.00
$10,880.00
24
HMA Surface, 9.5mm, Type B
2541
77.00
$195,657.00
25
HMA Intermediate, 19.Omm, Type B
812
TON
68.00
$55,216.00
26
HMA Base, 25mm, Type B
1222
TON
63.00
$76,986.00
27
Asphalt for Tack Coat
9
TON
1.00
$9.00
BID/PROPOSAL
CITY OF SOUTH BEND
PROJECT NAME:
Roadway Reconstruction
PROJECT NO.
121-008
,eas
FOR BIDS DUE:
June 8, 2021
CONTRACTOR NAME:
Milestone Contractors North, Inc.
BASE
BID
28
Joint Adhesive, Surface
10115
LFT
0.10
$1,011.50
29
Joint Adhesive, Intermediate
2394
LFT
0.10
$239.40
30
PCCP, 10 IN.
1615
SYS
85.00
$137,275.00
31
PCCP, 6 IN.
719
SYS
80.00
$57,520.00
32
PCCP, 8 IN.
208
SYS
100.00
$20,800.00
33
Retrofitted Tie-Bars
130
EACH
35.00
$4,550.00
34
D-1 Contraction Joint
792
LFT
24.00
$19,008.00
35
PCCP Patching, Full Depth
35
SYS
250.00
$8,750.00
36
Fence, Farm Field,47 IN.
53
LFT
65.00
$3,445.00
37
Fence, Chain Link, 48 IN.
304
LFT
45.00
$13,680.00
38
Brick Pavement Patching
50
SFT
68.00
$3,400.00
39
Sidewalk, Concrete
2892
SYS
50.00
$144,600.00
40
Sidewalk, Concrete, Modified
34
SYS
90.00
$3,060.00
41
Curb Ramp, Concrete
235
SYS
140.00
$32,900.00
42
Standard Curb
3484
LFT
32.00
$111,488.00
43
Standard Header
58
LFT
45.00
$2,610.00
44
Combination Curb & Gutter, Type A
523
LFT
45.00
$23,535.00
45
Combination Curb & Gutter, Type B
2382
LFT
32.00
$76,224.00
46
HMA for Approaches, Type B
90
TON
120.00
$10,800.00
47
Mailbox Assembly, Reset Single
8
EACH
95.00
$760.00
48
Mulched Seeding, U
2001
SYS
2.76
$5,522.76
49
Mob. & Demob. For Seeding
5
EACH
375.00
$1,875.00
50
Reinforcing Bars
833
LBS
3.30
$2,748.90
51
Pipe, Type 2, Circular, 12 IN.
71
LFT
55.00
$3,905.00
52
Standard Shallow Manhole & Casting
1
EACH
3,900.00
$3,900.00
53
Standard Inlet & Casting
3
EACH
3,100.00
$9,300.00
54
Inlet, A2
1
EACH
2,600.00
$2,600.00
55
Inlet, Clean Existing
4
EACH
400.00
$1,600.00
56
Patching Concrete Structures
60
SFT
100.00
$6,000.00
57
Manhole, Type A, 4' Dia., Type 1 Frame, Closed I 5
EACH
Lid
5,600.00
$28,000.00
BID/PROPOSAL
CITY OF SOUTH BEND
PROJECT NAME:
PROJECT NO.
FOR BIDS DUE:
CONTRACTOR NAME:
BASE BID
58 Manhole Adjust to Grade
59 Adjust Water Valve to Grade
60 Adjust Inlet to Grade
61 Removing Manholes
62 12 IN. Diameter Gravity Sanitary Sewer (8-10 FT
Deep)
63 18 IN. Diameter Gravity Sanitary Sewer (10-20
FT Deep)
64 Bypass Pumping
65 Sewer Service Reinstatement
66 Traffic Loop Replacement
67 Traffic Detector Housing Replacement
68 Line, Thermoplastic, Solid, White, 4 IN.
69 Line, Thermoplastic, Solid, Yellow, 4 IN.
70 Transverse Marking, Thermoplastic, Stop Line,
White 24 IN.
71 Transverse Marking, Thermoplastic, Crosswalk
Line. White, 6 IN.
72 Transverse Message Marking, Thermoplastic,
Lane Indication Arrow
73 Transverse Marking, Multi -Component, Stop
Line, White, 24 IN.
74 Transverse Marking, Multi -Component,
Crosswalk Line, White, 6 IN.
Bidder(Firm):
Address:
City/State/Zip
Telephone Number:
Fax Number:
Roadway Reconstruction
121-008
June 8, 2021
Milestone Contractors North, Inc.
6
EACH
1,450.00
$8,700.00
1
EACH
125.00
$125.00
21
EACH
1,800.00
$37,800.00
5
EACH
1,200.00
$6,000.00
619
LFT
80.00
$49,520.00
87
LFT
240.00
$20,880.00
5
EACH
2,400.00
$12,000.00
25
EACH
2,045.00
$51,125.00
6
EACH
400.00
$2,400.00
1
EACH
500.00
$800.00
94
LFT
15.00
$1,410.00
358
LFT
5.00
$1,790.00
165
LFT
24.00
$3,960.00
882
LFT
3.10
$2,734.20
2
EACH
200.00
$400.00
LFT
22
29.00
$638.00
LFT
43
6.25
$268.75
BASE BID
TOTAL
$2,398,000.00
Milestone Contractors North, Inc.
24358 SR 23
South Bend,IN 46614
574-288-481
574-289-7,174/
(Signature)
Dustin Hilary, V.P. of South Bend Area
(Printed Name of Person Signing)
,; 4SOIiTI;.BE��� n
.0
1316 COUNTY -CITY BUILDING 'a z a PHONE 574/235-9251
227 W. JEFFERSON BOULEVARD " x _ ]Rfu x s FAX 574/ 235-9171
SOUTH BEND, INDIANA 46601-1830 TDD 574/ 235-5567
CITY OF SOUTH BEND, JAMES MUELLER, MAYOR
BOARD OF PUBLIC WORKS
Date: June 3, 2021
To: All Planholders
From Anne Fuchs, Clerk, Board of Public Works
Subject Addendum Number: 1
Project Name:
Roadway Reconstruction
Project Number: 121-008
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM
Date Received: 6/3/2021
This addendum is being forwarded to you for the above referenced project.
Please sign below and acknowledge receipt of this Addendum
by faxing this sheet to the Board of Public Works at (574) 235-9171
within 48 hours of receipt. A copy MUST also be included with your
bid package upon submittal.
THIS ADDENDUM MAY AFFECT YOUR BID.
Notes:
The attached documents are hereby added to the Specifications and Contract
Documents and become a part of herein.
Company:
Authorized Signature:
Date:
Version 4/2/2015
Inc.
P. Wary, Director of Estimating, South Bend
CITY OF SOUTH BEND
4
r
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MWBE-1.0
MWBE UTILIZATION PLAN
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MBE participation. It is
the bidder's sole responsibility to verify whether any listed minority or woman business meets the MBE qualifications.
Project Number: 121-008 Project Name: Roadway Reconstruction
Bidder: Milestone Contractors North, Inc. Total Bid Amount: $2,398,000.00
Name & Address of MBE Primary Contact Person
(Name/Telephone)
C. Lee Construction Services, Inc. Frederick "Chip" Lee
1011 S. Lake Street 219-888-9554
Gary, IN 46403
Submitted by: Dustin P. Hilary, Director of Estimating,
Print Name South Bend
Scope of Work to be Performed
(Attach scope/schedule if you need additional space)
Hauling
Version 01/13/2021 Contractor's Bid for Public Works - 10
MBE Goal: 3.2%
Page 1 of 1
Dollar Amount of MBE Percentage?
Component of Total
1
$76,800.00
6/8/2021
Date
3.2%
ra, —rift
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MWBE-1.0 1Y
k
MWBE UTILIZATION PLAN
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving WBE participation. It is
the bidder's sole responsibility to verify whether any listed minority or woman business meets the WBE qualifications.
Project Number: 121-008 Project Name:
Bidder: Milestone Contractors North, Inc.
Name & Address of WBE
Primary Contact Person
(Name/Telephone)
Roadway Reconstruction
Total Bid Amount: _ $2 398,000.00
Scope of Work to be Performed
(Attach scope/schedule if you need additional space)
WBE Goal: 5.6%
Page 1 of 2
Dollar Amount of WBE Percentage
Component of Total
Traffic Control Specialits, Inc. Brian Triska
Traffic Control/MOT and Pavement Markings
1810 W. Pacific Ave 574-772-7001
$51,941.00
2.16%
Knox, IN 46534
Hawk Enterprises, Inc.
Greg b
Traffic Loops/Detectors
1850 E. North Street
219-662-80
62-8090
Housing
$3,700.00
0.15%
Crown Point, IN 46307
Slusser's Green Thumb, Inc. Nelson Slusser
125 Montgomery Street 574-722--3102
Permanenet & Temporary Seeding
$14,000.00
0.58%
Logansport, IN 46947
BUC Construction Supply, Inc. Teresa Butler
P.O. Box 4153
Direct material purchase pipe and castings
$36,000.00
1.50%
765-201-0064
Lafayette, IN 47903
Submitted by: Dustin P. Hilary, Director of Estimating,
Print Name South Bend
Version 01/13/2021 Contractor's Bid for Public Works - 11
6/8/2021
Date
4 ih 86b
CITY OF SOUTH BEND d
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MWBE-1.0 _
x
MWBE UTILIZATION PLAN
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving WBE participation. It is
the bidder's sole responsibility to verify whether any listed minority or woman business meets the WBE qualifications.
Project Number: 121-008 Project Name:
Roadway Reconstruction
Bidder: Milestone Contractors North, Inc.
Total Bid Amount: $2.398,000.00
WBE Goal:
5.6%
Page 2
of 2
Name & Address of WBE
Primary Contact Person
Scope of Work to be Performed
Dollar Amount of WBE
Percentage
of Total
(Name/Telephone)Attach
sco cope/schedule if you need additional s ace
( P Y P )
Component
P
Q
V&R Trucking, Inc. Veda Godette
1845 North Elmer Street 574-234-1268 Hauling
South Bend, IN 46628
Submitted by:
Dustin P. Hilary, Director of Estimating,
Print Name South Bend nature
Version 01/13/2021 Contractor's Bid for Public Works - 11
$29,100.00
6/8/2021
Date
1.21%
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN".
FORM MWBE-2.0
EVIDENCE OF GOOD FAITH EFFORTS
This completed form should be included as part of the Bids documents related to City of South Bend Public
Works Projects requiring Good Faith Efforts to obtain MWBE participation.
Project Number: 121-008 Date: 6/8/2021
Project Name:
Bidder:
Contact Person:
Address:
Roadway Reconstruction
Milestone Contractors North, Inc.
Edward Pilipow Telephone: 574-288-4811
24358 SR 23
City: South Bend State: Indiana zip: 46614
Email: epilipow ,�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*:
Version 01/13/2021 Contractor's Bid for Public Works - 12
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: httr.://www.in.cov/idoa/.
GOOD FAITH EFFORTS TO OBTAIN MWBE PARTICIPATION
The bidder shall initial each item below, as evidence of its good faith efforts to obtain MWBE
participation in the awarded contract.
I affirm that I reviewed the City of South Bend's Minority and Women Business Enterprise
Inclusion Program Plan and the Indiana Department of Administration's certified list of
Indiana Minority and Women Business Enterprises, found on their website
j-�
httr,://www.in.cov/idoa:..
I affirm that I have made good faith efforts to select portions of the contract work to be
performed by MWBEs, including, where appropriate, breaking out contract work items into
economically feasible units to facilitate MWBE participation.
I affirm that I have made good faith efforts to solicit through all reasonable and available
means the interest of all MWBEs in the scopes of work of the contract.
I affirm that I attended all pre-bid meetings scheduled by the City of South Bend to inform
MWBEs of contracting and subcontracting opportunities.
r •�
affirm that I advertised in general circulation and/or trade association publications
concerning subcontract opportunities and allowed MWBEs reasonable time to respond to
fi 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
)IF sufficient time for MWBEs to participate effectively.
I affirm that I followed up on initial solicitations with interested MWBEs.
a
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
f
of the subcontract.
I affirm that I have made good faith efforts to assist interested MWBEs in obtaining
bonding, lines of credit, or insurance as required by the City or the bidder, where
G✓
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
EVIDENCE OF GOOD FAITH EFFORTS
I affirm that I have made good faith efforts to assist interested MWBEs in obtaining
necessary equipment, supplies, materials, or related assistances or services, where
appropriate.
I affirm that I did not reject any MWBEs as unqualified without sound business reasons
P11based on a thorough investigation of their capabilities.
CONTRACT RECORDS: The bidder has maintained the following records for each MWBE that has bid
on the subcontracting opportunity:
1. Name, address, and telephone number;
2. A description of information provided by the bidder or subcontractor; and
3. A statement of whether an agreement was reached, and if not, why not, including any reasons for
concluding that the MWBE was unqualified to perform the job.
*Proper demonstration of Good Faith Efforts requires your initials next to all of the above boxes. Any
omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of
South Bend reserves the right to request additional information.
Version 01/13/2021 Contractor's Bid for Public Works -13
CITY OF SOUTH BEND r
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MWBE-2.1
MWBE CONTACTED
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects
requiring Good Faith Efforts to contact MBEs. It is the bidder's sole responsibility to verify whether any listed
minority or woman business meets the MBE qualifications. Attach additional pages if necessary.
PAGE 1 OF 1
Project Number: 121-008 MBE Participation Goal 3.2%
Project Name: Row
a
Bidder: ilex
By: �
Reconstruction
Inc.
Director of Estimating, South Bend 6/8/2021
'7
gnature) Dustin P. Hilary (Title) (Date)
WE Firm C. Lee Construction Services Inc.
Owner or Contact at MBE Firm Frederick "Chip" Lee
Telephone: 219-888-9554 Fax: 219-888_9564 Email: Chi cleecsi.com
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Hauling
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: Email:
TYPE OF WORK SOLICITED FOR THIS PROJECT
RESULTS OF CONTACT WITH THE MBE FIRM:
Version 01/13/2021 Contractor's Bid for Public Works - 14
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN :x
FORM MWBE-2.1 -..?Jo
MWBE CONTACTED
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects
requiring Good Faith Efforts to contact WBEs. It is the bidder's sole responsibility to verify whether any listed
minority or woman business meets the WBE qualifications. Attach additional pages if necessary.
PAGE 1 OF 3
Project Number: 121-008 WBE Participation Goal 5.6%
Project Name:
Bidder: %
By:
I R adway Reconstruction
LII estone Contractors North, Inc.
Director of Estima
Dustin P. Hilary (Title)
WBE Firm Traffic Control Specialists, Inc.
Owner or Contact at WBE Firm Brian Triska
Telephone: 574-779-7nn 1
South Bend 6/8/2021
(Date)
Fax: 574-772-7002 Email: estimating@tcsspecialists.net
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Traffic Control/MOT and Pavement Markings
RESULTS OF CONTACT WITH THE WBE FIRM:
If Milestone Contractors North, Inc. is awarded the project, we'll subcontract Traffic Control
Specialists, Inc. for their work.
WBE Firm Hawk Enterprises, Inc.
Owner or Contact at WBE Firm Greq Neulieb
Telephone: 219-662-8090 Fax: 219-662-8093 Email: re hawk-inc.com
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Traffic Loops/Detectors
Housiniq
RESULTS OF CONTACT WITH THE WBE FIRM:
If Milestone Contractors North, Inc. is awarded the project, we'll subcontract Hawk Enterprises, Inc.
for their work.
Version 01/13/2021 Contractor's Bid for Public Works - 15
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MWBE-2.1
MWBE CONTACTED
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects
requiring Good Faith Efforts to contact WBEs. It is the bidder's sole responsibility to verify whether any listed
minority or woman business meets the WBE qualifications. Attach additional pages if necessary.
PAGE 2 OF 3
Project Number: 121-008 WBE Participation Goal 5.6%
Project Name: Roadway Reconstruction
Bidder:zx--
stone Contractors North Inc.
By: Director of Estimating, South Bend 6/8/2021
r i nature) Dustin P. Hilary (Title) (Date)
:N E Firm Slusser's Green Thumb Inc,
Owner or Contact at WBE Firm Nelson Slusser
Telephone: 574-722-3102 Fax: Email: nts _,slussers.com
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Permanent and Tempraly Seeding
RESULTS OF CONTACT WITH THE WBE FIRM:
If Milestone Contractors North, Inc. is awarded the project, we'll subcontract Slusser's Green Thumb, Inc.
for their work.
WBE Firm BUC Construction Supply, Inc.
Owner or Contact at WBE Firm Teresa Butler
Telephone: 765-412-3484 Fax: Email: tcAbbucconstructionsupply.com
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Direct material purchase pipe and castings
RESULTS OF CONTACT WITH THE WBE FIRM:
If Milestone Contractors North, Inc. is awarded the project, we'll purchase materials from BUC
Construction Supl2ly, Inc.
Version 01/13/2021 Contractor's Bid for Public Works -15
CITY OF SOUTH BEND ll
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_3 _OF 3
Project Number: 121-008 WBE Participation Goal 5.6%
Project Name: Roadway Reconstruction
Bidder: ' stone Contractors North Inc.
f
By: f� Director of Estimating, South Bend 6/8/2021
('g ure) Dustin P. Hilary (Title) (Date)
WBIE rm V&R Trucking,Inc.
Owner or Contact at WBE Firm Veda Godette _
Telephone: 574-234-1268 Fax: 574-234-0748 Email: rfightingirish aol.com
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Hauling
RESULTS OF CONTACT WITH THE WBE FIRM:
If Milestone Contractors North, Inc. is awarded the project, we'll lease V&R Trucking Inc. for hauling.
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
L 1_
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
any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefr9l,
provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein. WIVN
furnished, the intent is that this Bond shall be construed as a statutory bond and not as a common law bona o
Signed and sealed this 8th day of
(Wit ss) Alisha Krueger
(Witness) Chris ine ng
June 2021
Milestone .C' ra rs North, Inc.
(Principe ���
B
uS in P. Hilary, Bend
ontinental Casualty Company
(Title) Kathryn 5E. 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.
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V a ctors
....
0 R A TF '. S
. SEAL
co0P4AApt`
-"Seal)
1807
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)
Roadway Reconstruction; Project No. 121-008
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
any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefr9l,
provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein. WIVN
furnished, the intent is that this Bond shall be construed as a statutory bond and not as a common law bona o
Signed and sealed this 8th day of
(Wit ss) Alisha Krueger
(Witness) Chris ine ng
June 2021
Milestone .C' ra rs North, Inc.
(Principe ���
B
uS in P. Hilary, Bend
ontinental Casualty Company
(Title) Kathryn 5E. 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.
,mblki 11fill.
V a ctors
....
0 R A TF '. S
. SEAL
co0P4AApt`
-"Seal)
1807
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, Inca
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.
�2aPx' GA518 oe
CORFORAre 00 0tW W4
Z � a JULY !I,
QU SEAL C y 1902 s
ISO MAR�r" •
State of South Dakota, County of Minnehaha, ss:
Continental Casualty Company
National Fire Insurance Company of Hartford
American Ca lty Company of Re ing, Pennsylvania
Paul T. Bruflat toe President
On this 27th day of February, 2018, before me personally came Paul T. Bruflat to me known, who, being by me duly sworn, 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.
ISJ. MOHR
NMAWP IBLIC
SOU7N -Ab
My Commission Expires June 23, 2021 J. Mohr V 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.
�,��QkSlJ�lr} %%SUR,I,y� G� OR
~+
- coavok�rr i � ��' �NceaPrwgTFo �
JULY 11, �
?897, *^` - � JIAR�r" •
Form F6953`4/2012
Continental Casualty Company
National Fire Insurance Company of Hartford
American Casualty Company of Reading, Pennsylvania
D. Johnson Assistant Secretary
Go to www.enasurety.com > Owner / Obligee Services > Validate Bond Coverage, if you want to verify bond authenticity.
Authorizing By -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`s 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 25h 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'Ito 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 Roadway Reconstruction
Project No. 121-008
For Bids Due June 8, 2021, until 9:00 am Local Time
Contractor Name: Milestone Contractors North, Inc.
The City seeks to enhance its ability to identify responsive and responsible bidders on all City public works
projects by institution of comprehensive submission requirements in compliance with State law. Quality
workmanship, efficient operation, safety, and timely completion of projects requires that all bidders meet
certain minimum requirements to be responsive and responsible bidders.
THIS FORM MUST BE SUBMITTED WITH YOUR BID.
INSTRUCTIONS:
If you are a pre -qualified bidder, complete Section I only.
If you are not a pre -qualified bidder, complete Section II only.
Section II acts as an application for pre -qualification. Submission of Section II will allow the bidder to be
considered for pre -qualification for bids with the City of South Bend Department of Public Works. Pre-
qualified bidders will then be exempt from a portion of the submission requirements outlined in Section 6-
63 of The Responsible Bidding Ordinance No. 10594-18 (hereinafter, "Responsible Bidding Ordinance")
for a period of twelve (12) months.
Thereafter, contractors who are pre -qualified must submit a complete application for continuation of "pre-
qualified" standing, on a form provided by the City ("Responsible Bidder Checklist (1) Pre -Qualified
Bidders") by December 31st for the upcoming calendar year, or within twelve (12) months of obtaining pre-
qualified standing. If the status of any item changes within the twelve (12) months, it is the responsibility of
the contractor to notify the City. Failure by any pre -qualified contractor to submit its complete application
for continuation of "pre -qualified" standing within the time prescribed above shall result in automatic removal
of the designation, effective January 1 of the following year, or immediately following the twelve (12) months
of pre -qualified standing.
However, the "removed" contractor or subcontractor shall still be permitted to bid on City public works
projects, though the contractor must submit all required documents under 6-63 until "pre -qualified" status
is re-established.
Please Note: The City reserves the right to request supplemental information from the bidder,
additional verification of any information provided by the bidder, and may also conduct random
inquiries of the bidder's current and previous customers regardless of pre -qualified standing.
It is the sole responsibility of the potential bidder to comply with all submission requirements applicable to
the bidder in Section 6-63 of the Responsible Bidding Ordinance no later than the date of the public bid
opening.
Version 01/13/2021 General Conditions - 6
POST BID SUBMISSIONS:
Post -bid submissions must be submitted in accordance with Section 6-64 of the Responsible Bidding
Ordinance. The post -bid submission requirements are as follows:
1. All bidders shall collect, maintain, and provide upon request, a current written list that discloses the
name, address, licensing status, and type of work for any subcontractor from whom the bidder has
accepted a bid and/or intends to hire on any part of the public work project, including individuals
performing work as independent contractors.
2. Each subcontractor, whose portion of the project is estimated to be at least one -hundred fifty
thousand dollars ($150,000.00), shall be required to adhere to the requirements of Section I of the
Responsible Bidder Ordinance as though it were bidding directly to the City, except that the
subcontractor shall submit the required information (including the name, address, and type of work)
to the successful bidder prior to the commencement of work.
3. Failure of a subcontractor to submit the required information shall not disqualify the successful
bidder from performing work on the project and shall not constitute a contractual default and/or
breach by the successful bidder. However, the City may withhold all payment otherwise due for
work performed by a subcontractor, until the subcontractor submits the required information and
the City approves such information.
4. The disclosure of a subcontractor list ("Disclosed Subcontractor(s)") to the City by a bidder shall
not create any rights in the Disclosed Subcontractor(s). Thus, a bidder may substitute another
subcontractor for a Disclosed Subcontractor by giving the City, upon request, written notice of the
name, address, licensing status, and type of work of the substitute subcontractor.
5. The successful bidder and all subcontractors on a public works project are required to submit
certified payroll utilizing the federal form known as WH -347 or a similar form on a bi-weekly basis,
submitted within 10 days after the end of each bi-weekly payroll period. Certified payrolls shall
identify the job title and craft for each employee. Certified payrolls shall be submitted
electronically.
Please Note: Submissions deemed inadequate, incomplete, or untimely by the City may result in
the automatic disqualification of the bid.
The City, after review of complete and timely submissions, shall, in its sole discretion, after taking into
account all information in the submission requirements, determine whether a bidder is responsive and
responsible, and provide a Pre -Qualification Verification Letter. The City specifically reserves the right to
utilize all information provided in the contractor's submission and any information obtained by the City
through its own independent verification of the information provided by the contractor
Version 01/13/2021 General Conditions - 7
PRE -QUALIFIED BIDDER CHECKLIST
(a) Acknowledgements:
(i) X By checking this box, I hereby acknowledge that I am a pre -qualified bidder with
the City of South Bend and that I have met the pre -qualification requirements within
the last twelve (12) months. A copy of my Pre -Qualification verification letter
is attached.
(ii) X By checking this box, I hereby acknowledge that the City reserves the right to
request supplemental information, additional verification of any information
provided by me, and may also conduct random inquiries of my current and prior
customers.
(b) Attachments:
(i) X Indiana Secretary of State's on-line records (ie. Business verification) dated within
sixty (60) days of the submission of said document showing that business is in
existence, current with the Indiana Secretary of State's Business Entity Report,
and eligible for a certificate of good standing. (Not applicable to individuals, sole
proprietors or partnerships).
(ii) X Statement on staffing capabilities, including labor sources. This statement
indicates and ensures I have sufficient employees on staff to complete the work. It
outlines how I intend to meet the staffing needs of the work.
(iii) X List of projects of similar size and scope of work performed in all areas, including
the State of Indiana, within the last three (3) years.
(iv) X For every project, submit evidence of participation in apprenticeship and training
programs, applicable to the work to be performed on the project, which are
approved by and registered with the United States Department of Labor's Office of
Apprenticeship, or its successor organization.
Version 01/13/2021 General Conditions - 8
II. PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED)
(a) Acknowledgements:
(i) _ By checking this box, I hereby acknowledge that I am not a pre -qualified bidder
with the City of South Bend.
(ii) _ By checking this box, I hereby acknowledge that the City reserves the right to
request supplemental information, additional verification of any information
provided, and may also conduct random inquiries of my current and prior
customers. The City reserved the right to utilize all information provided in this
submission and all information obtained in inquiries or requests to determine if a
bidder is responsive and responsible. Additionally, I acknowledge that all
information provided to the City shall be regarded as public records.
(iii) _ By checking this box, I hereby acknowledge that copies of all Applicable
apprenticeship certificates or standards for training programs applicable to the
work performed on the project may be requested at any time and shall be furnished
upon request.
(iv) _ By checking this box, I hereby acknowledge and ensure that I and all sub-
contractors, from whom I have accepted a bid and/or intend to hire to perform work
on the public work project, are properly licensed. Furthermore, I acknowledge my
understanding that it is my responsibility to ensure that all sub -contractors have
the necessary licenses to undertake the work called for in this bid. If a sub-
contractor loses their license at any point, it is the responsibility of that sub-
contractor to notify the City.
(b) Attachments:
(i) _
Indiana Secretary of State's on-line records (ie. Business verification) dated within
sixty (60) days of the submission of said document showing that business is in
existence, current with the Indiana Secretary of State's Business Entity Report,
and eligible for a certificate of good standing. (Not applicable to individuals, sole
proprietors or partnerships).
(ii) _
List identifying all former business names.
(iii) _
Any determinations by a court or governmental agency any violations of federal
state, or local laws including, but not limited to, violations of contracting or antitrust
laws, tax or licensing laws, environmental laws, Occupational Safety and Health
Act (OSHA), or federal Davis -Bacon and related Acts, within the preceding five (5)
years.
(iv) _
Statement about staffing capabilities, including labor sources. This statement
indicates and ensures I have sufficient employees on staff to complete the work I
am bidding on OR outlines how I intend to meet the staffing needs of the work.
(v) _
Statement that individuals who will perform work on the public work project on my
behalf will be properly classified as an employee or as an independent contractor
under all applicable state and federal laws and local ordinances.
(vi) _
For every project, submit evidence of participation in apprenticeship and training
programs, applicable to the work to be performed on the project, which are
approved by and registered with the United States Department of Labor's Office of
Apprenticeship, or its successor organization.
(vii) _
Copy of a written plan for employee drug testing that covers all of my employees
who will perform work on the public work project and meets or exceeds the
requirements set forth in IC 4-13-18-5 or IC 4-13-18-6.
(viii) _
Evidence that I am utilizing a surety company which is on the Bureau of Fiscal
Service "Department of Treasury's Listing of Approved Sureties" as required in the
bid specifications or contract.
Version 01/13/2021 General Conditions - 9
Date:
(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.
6/8/2
Efustin P. Hilary
(Print Name Here)
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.
dhilary&walshkelly.com
RE: Pre -Qualification Verification
Dear Mr. Hilary:
This letter serves as verification of Pre -Qualification status of your company for bidding
with the City of South Bend. This Pre -Qualification status is effective for twelve (12)
months from the date of this letter. Thereafter you are required to re -submit a complete
application for continuation of pre -qualification status prior to December 31 for the
upcoming calendar year.
A copy of this Verification Letter must be included with every bid exceeding $150,000
submitted to the City of South Bend Board of Public Works, along with your Pre -Qualified
Bidder Checklist and attachments.
If you have any further questions regarding this matter, please call this office at (574) 235-
9251.
Sincerely,
Dlgkally signed by Liz Horvath
Liz Horvath D"` —thgU. N'
mail=lhOrvalh@ ,,.endingw,
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CONTRACTOR'S BID FOR PUBLIC WORK — FORM 96
State Form 52414 (8212-13) t Form 96 (Revised 2013)
1 Prescribed by State Board of Accounts
PART
(To be completed for all bids. Please type or print)
Date (month, day, year): 6/8/2021
1. Governmental Unit (Owner): City of South Bend, Indiana
2. County; St. Joseph
3. Bidder (Firm): Milestone Contractors North, Inc.
Address: 24358 SR 2 _
CitylState/ZlPcode: _South Bend, IN 46614 _
4. Telephone Number: 574-288-4811, _ _
5. 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 Roadway Reconstruction Project No. 121-008
(Governmental Unit) in accordance with plans and specifications prepared by
Hanson Professional Services, Inc. _ and dated
5/12/2021 for the sum of
See Attached _ __ $ _See Attaphed_ _
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 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 on a separate attachment.
The contractor and his subcontractors, if any, shall not discriminate against or intimidate any employee,
or applicant for employment, to be employed in the performance of this contract, with respect to any matter
directly or indirectly related to employment because of race, religion, color, sex, national origin or ancestry.
Breach of this covenant may be regarded as a material breach of the contract.
CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS
(If applicable)
I, the undersigned bidder or agent as a contractor on a public works project, understand my statutory
obligation to use steel products made in the United States (I.C. 5-16-8-2). 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 $950,000 or more -1C 36-9-12-4)
Governmental Unit: Cityof 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 I
91946,272.00
Reconstruction
May 2020 INDOT
4,287,140.00
Resurface
November 2020
Lake County H V Dept
4 104 874.00
Resurface
December 2020
St. Joseph County Airport Authority
3,698,954.00
Resurface
_ October 2020
.INDOT J�
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,,917x653.00 Resurface May 2021 INDOT
6716400.00 Reconstruction_ December 2021, INDOT
5 126 831.00 Reconstruction November 2021 INDOT_
1 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 recuired by owner
2. Please list the names and addresses of all subcontractors (i.e. persons or firms outside your own firm
who have performed part of the work) that you have used on public works projects during the past five (5)
years along with a brief description of the work done by each subcontractor.
See attached list
3. if you intend to sublet any portion of the work, state the name and address of each subcontractor,
equipment to be used by the subcontractor, and whether you will require a bond. However, if you are
unable to currently provide a listing, please understand a listing must be provided prior to contract
approval. Until the completion of the proposed project, you are under a continuing obligation to
Immediately notify the governmental unit in the event that you subsequently determine that you will use a
subcontractor on the proposed project.
Will supply upon award of contract _ _
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 swom on oath, says that he has not, nor has any other
member, representative, or agent of the firm, company, corporation or partnership represented by him, entered
into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such
letting nor to prevent any person from bidding nor to 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 8th day of June 2021
,��111111//
Milestone Con G rs
County of Residence: LaPorte _
(Neme�ofOrg8afzdtion)
•e
tom. J
3 e RR�.. 3 =
Dustin P Hilary
Director of_Estimatin_ j South Ben
• S Y •
(7 Itle of Person Signing)
N
`N %%N
0',,,
ACKNOWLEDGEMENT
STATE OF Indiana }
ss
COUNTY OF St. Joseph
Before me, a Notary Public, personally appeared the above-named Dustin P. Hilary and
swore that the statements contained in the foregoing document are true and correct.
Subscribed and sworn to before me this 8th day of June 2021
Notary Publia Alisha Krueger
My Commission Expires:_ 6/5/22
coy"�e4� ALISHAKRUEGER
County of Residence: LaPorte _
_'"°T"�"':. La Porte County
a..s My Commission Expires
'�rFoc rp:'
June 5, 2022
Part of State Form 52414 (R212 -i3) ! Form 96 (Revised 2013)
Milestone Contractors North, Inc.
(Contractor)
24358 SR 23
(Address)
South Bend, IN 46614
FOR
PUBLIC WORKS PROJECTS
OF
City oL outh Bend. Indiana
Roadway Reconstruction
Project No. 121-008
Filed June 8th, , 2021
Action taken
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 8th. 2021
Filed
A.E. BOYCE CO., MUNCIE, IND.
1
IA 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. (Bums Statutes 1933, Sec. 53-109) Sec. 2, Chapter 306,
Acts of 1947.
IOm-re iDi:31 -11-11a :
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
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.
� STATF
�1•••'� ••.. In Witness Whereof, I have caused to be affixed my
signature and the seal of the State of Indiana, at the City
of Indianapolis, May 24, 2021
rrr�
''••........-•'''� #HOLLI SULLIVAN
7816 SECRETARY OF STATE
194484-057 J 20212030754
All certificates should be validated here: https:JJbsd.sos.in.gov/ValidateCertificate
Expires on June 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 fallowing 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 18878219
To ensure the certificate's validity, go to httfis:f/bsd sos in.gov/PubhcB&isiness5eaich
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.
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.
Co'�tixc,v C�"wm
CONNIE LAWSON
SECRFTARY OF STATE
194484.057 /8878234
To ensure the certificate's validity, go to https://bsd.sos.in-gov/PublicBusinessSearch
Form T�Jp .�
(P*v. October 2018)
00
Irdt3era � Servtoe��
Request for Taxpayer
Identification Number and Certification
W Go to wwwA*.yoy/formWV for inetructions and the latest Infommtion.
1 Name (as shown an your income tax return). Name Is required on this line; do not !save this fine
MILESTONE CONTRACTORS NORTH, INC.
2 Eluolness narriardsregarOsd wuity name. If different from above —
WALSH & KELLY, INC.
8 Check appropriate box for federal talc clesaifieation of the person whose name is entered on line 1. Check only one of the
following seven boxes.
❑ lnc1vid0aUaole proprleton Of ❑ C Corporation i] S Corporation ❑ partnertship ❑ Tnuat/eatale
singietm ffibsr LLC
❑ United liability company. Enter the tax classification (0-0 corporation, S■S corporation. P.Partnership)
Note: Check fits appropriate box In the line strove for the tax ciasclfirMlon of the single -member owner. Do not check
LLC N the LLC is Chit ltd as a efngle-member LLC that is disregarded from the owner unless the owner of the LLC is
another LLC that is not diereperdod from the owner for U.S. federal tax purposes. Otherwise. a slrpio-member LLC tin
is disrpparded from the owner should check the appropriate box for the tax elasafgcation of its owner.
❑ Other (see instnxlkxts) ►
5 Address (nuober, etnet, and apt or suite ro J Flea insrructions Requester's risme
1700 EAST MAIN STREET J
e City, state, and ZIP code �— 1
GRIFFITH, IN 46319 iI
7 List account number(e) here (optloneo -
Give Form to the
requester. Do not
send to the IRS.
4 Exatnptions (Codes apply Only to
certain entities, not rndlviduais; to
Instructions on page 3):
Exempt payee code (H any)
Exemption from FATCA repordn
cotta 0 an)
WOW 00 WW" WMI .darwar M use
Enter your TIN In the appropriate box. The TIN provided must match the name given on line 1 to avoid E 9galat security number
resident
withholding• For individuals, this to generally your sada* security fo Part O3Shi1. Frother
However. fora � _ (— ]
resident alien, tecta proprietor, or disregarded entity, see the instructions for Part 1, later. For cher {f f( II
entities, it Is your employer Identification number (EIM. It you do not have a number, we How to gat a
77N, later. or
Note: If the account is in more than tate name, ase the instructions for line 1. Aleo ass What Name and Emplow Id*nmcauon number
Number To Give the Requesterfor guidelines on whose number to enter. ti
3 5i 1 1 2 D 6 8
Certification
Under penalties of perjury, I certify that: --
1. The number shown on this form is my correct taxpayer identification number (or 1 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 wkhhoiding, 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 fallure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3.1 am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA oode(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is oorrem.
CeMftation instructions. You must cross out iter 2 above It you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report ail interest and dividends on your tax return. Forrest estate transections, ttem 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement. ORA), and generally, payments
other than Interest and dividends, you are not required to sign the certification, but you must provide your correct TIN, See tete instructions for Part 11, later.
6Iol signature of
Here u.S.parsonb- � ,�i.)Z i (?i (Y( �ic1?(jc� - �f; +rr,11C.: Date * `'11gI2t zl
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
refitted to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.lrs.gov1FormW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number MM which may be your social security number
(SSM, individual taxpayer identification number OTIM. adoption
taxpayer identification number WnN), or employer identification number
(EIN), to report on an information return the amourd paid to you, or other
amount reportable on an intom►stion return. Examples of information
returns include, but are not limited to, the following.
• Form 1099 -INT (interest earned or paid)
Cat. No.10231X
• Form 11799-OtV (dividends, Inckrding those from stocks or mutual
funds)
• Form 1099-tASC (various types of income, prizes, awards, or gross
proceeds)
• Form 1098-8 (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1088 (home mortgage interest), 10913-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.
If you do not return Form W-9 to the requester with a TIN, you might
be subject to backup wlthholding. See What is backup withholding,
later:
Form W-$ (flay, 1p-2018)
CERTIFICATE OF QUALIFICATION
to provide
CONSTRUCTION SERVICES
for
PUBLIC WORKS PROJECTS
to the
STATE OF INDIANA
This Certification Board, having duly considered application for qualification in terms of apparent experience and financial
resources; and under the applicable Indiana Code 4-13.6-4 and adopted rules of this Board, hereby issues a
Certificate of Qualification to provide construction services to the State of Indiana for Public Works Projects to:
WALSH - KELLY INC
1700 E MAIN ST
GRIFFITH IN 46319
Phone 219-924-5900
Fax 219-924-8768
Company Official
JOHN PEISKER
for the twenty-seven month period stated herein, unless revoked by this Board for cause,
and in the classifications of services stated below. This certificate supercedes any previous certificate.
1611.01 Concrete Construction of Roads & Curbing
1611.02 Asphalt Construction of Roads and Parking Lots
CERTIFICATION DATE 11/4/2020
EXPIRATION DATE 2/4/2023
THIS CERTIFICATE ISSUED BY THE STATE OF INDIANA, PUBLIC WORKS DIVISION CERTIFICATION BOARD,
402 WEST WASHINGTON STREET, ROOM W467, INDIANAPOLIS, INDIANA 46204,
ALSO ACTS AS THE OFFICIAL NOTICE OF EXPIRATION.
Esra
......
Tracy L. Cross, Ex tive Secretary
Certification Board d�
DAPW PQ2 State Forth 3983R Rev. 07/06
rm
\�`4
lato t
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 North, 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
--&gnatw.Y,P_agl? to_W-riuc.n.Con .t__
Dated effective as of the I" day of February, 2021
Fred Fehsenfeld, Jr.
AlbeitELklgf"
Albert EVanDenBergh(Mar 26,202120:2 DT)
Albert E. VanDenBergh
Geoffrey C. Dillon
James C. Fehsenfeld
John P. ercruysse
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 of the 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.
<zSrGNATURHS ON THXNEXT PAGE»
EXECUTED this 2"d day of February, 2021.
Fred Felysenfeld, Jr.
Aaee c 1/Ayt�`1�e�A�2
Albert E VanDenBergh(Mar26,20212R »
Albert E. VanDenBergh
Geoffrey C. Dillon
James C. Fe senfeld
John P. Vercruysse
Piil 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.
4
CJ Po s, Chief Operating Officer
Margaret Garner, HR Area Partner/EEO Officer
February 2021
%i\Milestone
DATE: February 26, 2021
TO: All Employees
RE: EEO Officer Appointment
Margaret Garner has been appointed Equal Employment Opportunity Officer for Milestone
Contractors. It is her responsibility to coordinate, advise and assist management and
supervisors in their responsibilities of assuring all applicants and employees' equal
opportunities in all aspects of their employment. She will review complaints that allege
discrimination because of race, religion, color, sex, sexual orientation, gender identity, age,
national origin, disability, housing status or veteran status.
Employees of Milestone Contractors are to submit any issues or concerns to Margaret. We are
committed to comply with the provisions of the Civil Rights Act of 1964 and 1991, plus all
Executive Orders issued relating to Equal Employment.
Margaret's contact information is listed below.
Milestone Contractors
7661 N Perimeter Rd, Suite 200
Indianapolis, IN 46241
m arner milestones .com
(317)616-4937
CJ P ts, Chief Operating Officer
EOE M/FNets/Disabled
(OrAtrwate of Qualifitcdian
iSStJED BY
41
INDIANAPOLIS, IN May 20, 2021
TO
MILESTONE CONTRACTORS NORTH, INC.
GRIFFITH, IN
who has filed with the Department a Comer's Statement of Experience and Financial Conditiori as
required under Indiana Code 6-23-10, is hereby qualified lo bid at any Department of Transportation
letting in Classes of Work and within the amount and other limitation of each classification as listed
below, for such period as the uncompleted wont on hand from all sources sloes notexceed the AaggWte
amount Classification references by name or symbol are in accordance with the definitions in the
Contractors Statement of Experience and Financial Condition. This cerlificate supersedes any certificate
previously issued, but is subject to revision or revocation avoording to the law, if and when changes
in the financial condition of the contracting 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
PREQUALIFICATION ENGINEER
SWa k-rn 2AN #43 lb,"
COt9 NUSSJONER
PREQUALIFICATION WORKSHEET
PRINTED: 05/20/2021
ACCOUNT #: 351120685 VALID: 05/19/2021
NAME: Milestone Contractors North, Inc. EXPIRES: 09/3012022
APPLICATION TYPE: New AUDITOR APPROVED: 05/1212021
FINANCIAL STATEMENT TYPE: Audit ANALYST APPROVED: 05/19/2021
FINANCIAL STATEMENT DATE: 12/31/2020 PREQUALIFICATION APPROVED: 05/20/2021
--------------------- --
ASSETS REPORTED
LIABILITIES REPORTED
-- -- --- ---.............
NETASSETS REPORTED
- - -----------------------
NET FIXED ASSETS
CURRENTFIXED EQUIPMENT
--------...------- -------------
$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
NET FIXED ASSETS EQUIPMENT $0.00
------------------------------------ -- ------ -----
NET ACCEPTABLE ASSETS $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
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
+ $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
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
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 PAYABLE1TOTAL CURRENT LIABILITIES:
------------------ --------------------
0.30
RECEIVABLES/PAYABLES:
-------------
3.74
DAYS IN ACCOUNTS RECEIVABLE:
42.27
ADJUSTMENTS
Line Item # - Description Adjustment Amount
Current 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 MASONRY AND 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: 05/1212021
ANALYST APPROVED: 05/1912021
PREQUALIFICATION APPROVED: 05/20/2021
Page 2 of 2