HomeMy WebLinkAboutOpening of Bids - Ward Bakery Exterior Improvements Proj No. 121-061R - J.W. Werntz & Son, Inc.4
C9
CITY OF SOUTH BEND, INDIANA' X'3
CONTRACTOR'S BID FOR PUBLIC WORK
CHECKLIST FOR BIDDERS
Project Name Ward Bakery Exterior Improvements
Project No. 121-061R
For Bids Due December 14, 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
or Bid Bond.
Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely
executed.
Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments
with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and
Certification of use of United States Steel Products or Foundry Products.
Proof of M/WBE Utilization Plans [MBE -1.0 and WBE-1.0]. Also provide Evidence of Good
Faith Efforts Forms [MBE -2.0 and WBE-2.0] and M/WBE Contacted Forms [MBE -2.1 and
WBE-2.1].
Acknowledge Receipt of Addendum(s) included with the bid.
I All required additional information is included with the bid.
Proposal statements and other affidavits all signed by the proper party with name either
— printed or typed underneath signature.
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 an does not
relieve the bidder of the need to read and comply with the specifications.
Bidder:
MA tkh, Date: l%
By Authorized Representative' -
Signature:E
Print Name & Title: i� F ( ir„
Version 09/29/2021 Contractor's Bid for Public Works - 1
Project Name Ward Bakery Exterior Improvements
Project No. 121-061R
For Bids Due December 14, 2021
Date:
Address:
City/State/Zip:
IT14
(Must be completed for all bids. Please type or pri )
C # Bidder (Firm): J OL, An n,
1(3.02,- i
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:
the City of South Bend, Indiana, in accordance with plans and specifications prepared by:
and dated W 3 O € for the sum of (enter the Total Bid as shown on the Proposal)
(s I P) 3, n M)
(Enter sum of Total Base Bid plus Alternates shown on Proposal) (Wmencal) {
The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in
the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance
with the notice. Any addendums attached will be specifically referenced at the applicable page.
If additional units of material included in the contract are needed, the cost of units must be the same as that
shown in the original contract if accepted by the City of South Bend. If the bid is to be awarded on a unit
basis, the itemization of the units shall be show o a separate attachment.
By 0) Iig
—1S ignature
`eR t) d NP me of Person Signing)
ACCEPTANCE
The above bid is accepted this _
Subject to the following conditions:
BOARD OF PUBLIC WORKS
Elizabeth A. Maradik, President
Gary A. Gilot, Member
day of
Joseph R. Molnar, Member
Jordan V. Gathers, Member
Murray L. Miller, Member Attest: Anne Fuchs, Clerk
Version 09/29/2021 Contractor's Bid for Public Works - 2
20
When the prospective Contractor is unable to certify to arty of the statennents beloul, it shalt attach (tit e. planation 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 --LJV, ' )
SS:
T --J eAM 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
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.
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.
Version 09/29/2021 Contractor's Bid for Public Works - 4
t 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 tern 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, terns,
conditions, or privileges of contract or employment, or any matter directly or indirectly related to contracting
or employment because of race, sex, religion, color, national origin, ancestry, gender expression, gender
identity, sexual orientation, or due to age 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. On goal -eligible contracts,
Contractors are required to either meet both MBE and WBE utilization goals or demonstrate that the
Contractor has made good faith efforts to obtain participation from MBE and WBE subcontractors. A finding
-of noncompliance or a discriminatory practice shall prohibit that Contractor from being awarded a City
contract for a period of one (1) year from the date of such determination, and such determination may also
be grounds for terminating the contact to which the discriminatory practice or noncompliance pertains.
7. The undersigned Contractor agrees that the following nondiscrimination commitment shall be made
a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its
agencies, boards or commissions.
Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the
performance of this contract with privileges of employment, or any matter directly or indirectly related to
employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation,
handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of
contract.
1, the undersigned bidder or agent as contractor on a public works project, understand my statutory
obligations to the use of steel products or foundry products made in the United States (I.C. 5-16-8-1).1 hereby
certify that I and all subcontractors employed by me for this project will use steel products or foundry
products made in the United States on this project if awarded. I understand I have an affirmative duty to
notify the City in my bid that my proposal does not include the use of steel products or foundry products
made in the United States. I understand it is my sole obligation and responsibility to provide a justification
to the City, subject to review and approval, why the cost of United States made steel or foundry products is
unreasonable. Prior to award and upon submission of bid which does not use steel products or foundry
products made in the United States, the City, through its director of public works, shall make a determination
,K
if the price of United States made steel or foundry is unreasonable. I understand that violations hereunder
Version 09/29/2021 Contractor's Bid for Public Works - 5
may result in forfeiture of contractual payments.
I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid
for public works are true and correct.
Dated this X day of C; 20 >
Cont for/Bidder LEiirnl
Signature of Contractor/Bidder or Its Agent
A4T,gicAl- 16-1215KIV 7–.z —7
Printed Name and Title
Subscribed and sworn to before me this day of Dt. C , 20,-,')/
My Commission Expires 11,211619 Z/i%'
Notary zutric
County of Residence
Hj�RRY P SEtktt:LETON
^Sc�tarY F.It, iir S 3 sIi 01 i'.6ana
�- t ,c r C,cin.y
a
c=+anas5iur, 67L554
t9Y r, ITr��17 4 .ton ExpirCS
Version 09/29/2021 Contractor's Bid for Public Works - 6
BID/PROPOSAL
CITY OFSOUTH BEND
Project Name: Ward Bakery Exterior Improvements
Project Number:
For Bids Due:
Contractor Name:
121-061
December 14, 2021
BID PACKAGE I — BASE BID
Item
Description
Quantity
Unit
Unit ice
Total Amount
Southeast portion of Portage Ave
90tity
Unit
Unit Price
Total Amount
No.
2 -Story Section (Main Floor and Upper-
1
LS
1
Level Facade (AREA A): Masonry
1
LS
Repair & Rehabilitation
I
LS
2
1 Construction Contingency Allowance Bid
each
Package 1
$5,000.00
BID PACBASE BID TOTAL
BP4.BID ALTERNATE 1-1 *'
BP -1, BID ALTERNATE 14TOTAL
Bp4.BID ALTERNATE 1-2 .�
�
Item
Description
Quantity
Unit
Unit Price
Total Amount
Description
90tity
Unit
Unit Price
Total Amount
No.
Southeast Portion of Portage Avenue
1
Northwest portion of Portage Avenue
1
LS
Fagade and a small section along North
I
LS
California Avenue Facade (AREA B):
Masonry Repair & Rehabilitation
BP -1, BID ALTERNATE 14TOTAL
Bp4.BID ALTERNATE 1-2 .�
�
Item
Description
Quantity
Unit
Unit Price
Total Amount
Southeast Portion of Portage Avenue
1
Ground Floor (AREAA -Ground Floor):
1
LS
Cosmetic Masonrygepair
BPA, BID ALTERNATE 1'2TOTAL
BP-1,B|OALTERN/�'E1'3
Item
Descripti
Quantity
Unit
Unit Price
Total Amount
Northwot Portion of Portage Avenue
Faqa,4A and North California Avenue
Fac e (AREA 13): Cosmetic Masonry
Rezr
BID ALTERNATE 1-3TOTAL
Version 09/29/2021 Contractor's Bid for Public Works 7
Project Name:
Project Number:
For Bids Due:
Contractor Name:
BID/PROPOSAL
CITY OF SOUTH BEND ;rz
Ward Bakery Exterior Improvements
121-061
December 14, 2021
ti.fa
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
Southeast Portion of Portage Avenue
1
Ground Floor (AREA A — Ground Floor):
1
LS
f=£,
I
Windows -Doors -Storefront
r`
64
2
Construction Contingency Allowance Bid
1
1
each
Package 2
$5,000.00
BID PACKAGE 2 - BASE BID TOTAL 7 j
BP -2, BID ALTERNATE 2-1
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
Southeast Portion of Portage Avenue
1
Upper -Level Facade (AREA A— Upper
1
LS
C O>
I
Level Facade): Windows
r`
64
BP -2, BID ALTERNATE 2-1 TOTAL S
BP -2, BID ALTERNATE 2-2
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
Northwest Portion of Portage Avenue
1
Fagade and a small section along North
1
LS
California Avenue Fagade (AREA B):w
r`
64
Windows -Doors -Storefront
Bidder (Firm):
Address:
City/State/Zip:
BP -2, BID ALTERNATE 2-2 TOTAL
Telephone Number: 0/6 0 3 61 V57)
BY e t
(Signature) i
'(h
(Printed Name of Person Signing)
Version 09/29/2021 Contractor's Bid for Public Works - 8
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE -1.0
MBE UTILIZATION PLAN
This completed form should be supplied with Bids that pertain to City of South Bend Public Works P
the bidder's sole responsibility to verify whether any listed minority-owned business meets the MBE
Project Number:
Bidder:
121-061R
BPI -Base Bid MBE Goal: 0.3%
Project Name: Ward Bakery Exterior
Total Bid Amount:
A/6
Rpm J.�
g MBE participation. It is
MBE Goal: 0.3%
Page of
Name & Address of
MBE
Primary Contact Person
(Namerrelephone)
Scope of Work to be erformad
(Attach scope/schedule if yo .deed additional space)
Dollar Amount of
MBE Component
Percentage of
Total BidlProposal
z
Base Bid MBE Totals
BPI -Alternate 1-1 MBE Goal: 0.3%
Name & Address of
MBE
Primary Contact Person
(NamefTelephone)
Scope of Work to be Performed
ttach scopetschedule if you need additional space)
Dollar Amount of
MBE Component
Percentage of
Total Bid/Proposal
�a
B
Alternate 1-1 MBE Totals
Vel
for Public Works — 9.1
iRTf p�
'1C
CITY OF SOUTH BEND (�
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAW PLAN i'; l>,�-
FORM MBE -1.0
MBE UTILIZATION PLAN
BPI -Alternate 1-2 MBE Goal: 0.3%
Name & Address of
Primary Contact Person
Scope of Work to be Performed"
Dollar Amount of
Percentage of
MBE
(NamelTelephone)
(Attach scopelschedule if you need additional space)
MBE Component
Total Bid/Proposal
Alternate 1-3 MBE Totals
.s
Alternate 1-2 MBE Totals
BP1-Alternate 1-3 MBE Goal: 0.3%
Name & Address of
MBE
Primary Contact Personcope
(Namerrelephone)
of Work to be Performed
(Attach Cope/schedule if you need additional space)
Dollar Amount of
MBE Component
Percentage of
Total Bid/Proposal
I
Alternate 1-3 MBE Totals
Subm
Versior
Signature
Date
CITY OF SOUTH BEND
Primary Contact Person
(Namerrelephone)
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRA LAN
Dollar Amount of
WBE Component
FORM WBE-1.0
1.
WBE 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 woman -owned business meetdthe WBE qualifications.
Project Number: 121-0618 Project Name: Ward Ba
Bidder: Total Bid
BPI -Base Bid WBE Goal: 3.6%
WBE Goal: 3.6%
Page of
Name & Address of
WBE
Primary Contact Person
(Namerrelephone)
S,. pe of Work to be Performed
(Attach s pe/schedule if you need additional space)
Dollar Amount of
WBE Component
Percentage of
Total Bid/Proposal
Base Bid WBE Totals
BP1-Alternate 1-1 WBE Goal: 3.6%
Name & Address of
WBE
Primary Contact Person
(Namerrelephone)
Scope of Work to be Performed
(Attach scope/schedule if you need additional space)
Dollar Amount of
WBE Component
Percentage of
Total BidlProposal
Alternate 1-1 WBE Totals
mtractor's Bid for Public Works — 9.3
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM WBE-1.0
WBE UTILIZATION PLAN
BPI -Alternate 1-2 WBE Goal: 3.6%
N, u
Name & Address of
WBE
Primary Contact Person
(Name/Telephone)
Scope of Work to be Performed ,;�
(Attach scope/schedule if you need additional spa )
Dollar Amount of
WBE Component
Percentage of
Total Bid/Proposal
Alternate 1-2 WBE Totals
BP1-Alternate 1-3 WBE Goal: 3.6%
Name & Address of
WBE
Primary Contact Person
(Namerrelephone)
Scope of Wo to be Performed
(Attach scope/schedu 'if you need additional space)
Dollar Amount of
WBE Component
Percentage of
Total Bid/Proposal
Alternate 1-3 WBE Totals
Submitted b
Version 10/11
Signature
Date
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE -1.0
MBE 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-owned business meets the MBE qualifications.
Project Number: --12--1-061R Project Name- Ward Bakery Exterior Im movements — Bid Package 2 Windows -Doors -Storefront
Bidder: pie. $
Total Bid Amount: /, f "" MBE Goal: 3.4%
Page of
BP2-Base Bid MBE Goal: 3.4%
Name & Address of
MBE
Primary Contact Person
(Name/Telephone)
Scope of Work to be Performed
(Attach scope/schedule if you need additional space)
Dollar Amount of
MBE Component
Percentage of
Total Bid/Proposal
p
E .:; M11 S
9"001
(/t?oz. '� Pr^
0
C
1.
Base Bid MBE Totals
BP2-Alternate 2-1 MBE Goal: 3.4%
Name & Address of
M�,�B^,v�E
Primary Contact Person
(Namerrelephone)
Scope of Work to be Performed
(Attach scopetschedule if you need additional space)
Dollar Amount of
MBE Component
Percentage of
Total SidlProposal
(�r
} Al/00z)
^
�
Alternate 2-1 MBE Totals
Version 10118/21 Contractor's Bid for Public Works —10.1
CITY OF SOUTH SEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE -1.0
MBE UTILIZATION PLAN
BP2-Alternate 2-2 MBE Goal: 3.4%
Name & Address of
MBE
Primary Contact Person
(Namerrelephone)
Scope of Work to be Performed
(Attach scopetschedule if you need additional space)
Dollar Amount of
MBE Component
Percentage of
Total Bid/Proposal
64-, 00-',7
AD
Alternate 2-2 MBE Totals
Submitted by:
tPrifit Name" -816-66tdrb Date
Version 10/18/21 Contractor's Bid for Public Works —10.2
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM WBE-1.0
WBE 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 woman -owned business meets the WBE qualifications.
Project Number: �1�ry2,1-061R Project Name: Ward Bakery Exterior Improvements— Bid Package 2 (Windows -Doors -Storefront)
Bidder: J,11i �4 Total Bid Amount: ,. WBE Goal: 4.5%
Page of
BP2-Base Bid WBE Goal: 4.5%
Name & Address of
WBE
Primary Contact Person
(Namefrelephone)
Scope of Work to be Performed
scope/schedule if you need additional space)
Dollar Amount of
WBE Component
Percentage of
Total Bid/Proposal
)
,f ,(Attach
t s°l
f^ 3
s
Base Bid WBE Totals
BP2-Alternate 2-1 WBE Goal: 4.5%
Name & Address of
WBE
Primary Contact Person
(Namerrelephone)
Scope of Work to be Performed
(Attach scope/schedule if you need additional space)
Dollar Amount of
WBE Component
Percentage of
Total Bid/Proposal
Alternate 2-1 WBE Totals
Version 10/18/21 Contractor's Bid for Public Works — 10.3
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM WBE-1.0
WBE UTILIZATION PLAN
BP2-Alternate 2-2 WBE Goal: 4.5%
Name & Address of
WBE
Primary Contact Person
(Namerrelephone)
Scope of Work to be Performed
(Attach scope/schedule if you need additional space)
Dollar Amount of
WBE Component
Percentage of
Total Bid/Proposal
fj -1
p�ryg 9 9
•._4.k',„i
Alternate 2-2 WBE Totals
Submitted by:
)
g t
ame a are Date
Version 10/18/21 Contractor's Bid for Public Works — 10.4
�%pQTFf I1
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE -2.0
EVIDENCE OF GOOD FAITH EFFORTS F�
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 MBE participation.
Project Number: 121-061R Date: �
F
Project Name:
Bidder:
Contact Person:
Address:
City:
Email:
To determine whether;
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':
I
Version 09/29/2021
Contractor's Bid for Public Works - 11
EVIDENCE OF GOOD FAITH EFFORTS
MBE LIST(S): The bidder reviewed 1) the City of South Bend's Minority and Women Business Enterprise
Inclusion Program Plan; 2) the list of certified MWBEs provided by the City; and 3) the Indiana Department
of Administration list of Minority and Women Owned Businesses (both certified and non -certified) found
at: http://www.in.g!2yt[Opa/.
GOOD FAITH EFFORTS TO OBTAIN MBE PARTICIPATION
The bidder shall initial each item below, as evidence of its good faith efforts to obtain MBE 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
(http://www.in.gov/idoa).
e
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 MBE participation.
I affirm that I have made good faith efforts to solicit through all reasonable and available
means the interest of all MBEs 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
MBEs of contracting and subcontracting opportunities.
I affirm that I advertised in general circulation and/or trade association publications
concerning subcontract opportunities and allowed MBEs reasonable time to respond to
t
such advertisements.
I affirm that I performed any and all necessary steps to provide written notices in a manner
reasonably calculated to inform MBEs of subcontracting opportunities and allowed
sufficient time for MBEs to participate effectively.
I affirm that I followed up on initial solicitations with interested MBEs.
affirm that I negotiated with interested MBEs in good faith, including providing such MBEs
with adequate information about the plans, specifications and other requirements of the
subcontract.
I affirm that I have made good faith efforts to assist interested MBEs in obtaining bonding,
lines of credit, or insurance as required by the City or the bidder, where appropriate.
Version 09/29/2021
Contractor's Bid for Public Works - 11
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE -2.0
EVIDENCE OF GOOD FAITH EFFORTS
*Proper demonstration of Good Faith Efforts requires your initials next to all of the above boxes. Any
omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of
South Bend reserves the right to request additional information.
Version 09/29/2021 Contractor's Bid for Public Works - 12
I affirm that I have made good faith efforts to assist interested MBEs in obtaining necessary
equipment, supplies, materials, or related assistances or services, where appropriate.
I affirm that I did not reject any MBEs as unqualified without sound business reasons based
on a thorough investigation of their capabilities.
CONTRACT RECORDS: The bidder has maintained the following records for each MBE 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 MBE 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 09/29/2021 Contractor's Bid for Public Works - 12
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM WBE-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: 121-061 R Date:
Project Name: Ward Bakery Exterior Improvements
Bidder: f`! '
Contact Person: ifs Telephone:
Address: /(7 Z— 1--4 f
City: State. 1 Y Zip:
Email: i l vl1)
To determine whether a bidder has de onstrated good faith efforts to reach the WBE 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 09/29/2021 Contractor's Bid for Public Works - 13
EVIDENCE OF GOOD FAITH EFFORTS
WBE 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: htt ://www.in. ov/idoa/.
GOOD FAITH EFFORTS TO OBTAIN WBE PARTICIPATION
The bidder shall initial each item below, as evidence of its good faith efforts to obtain WBE 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
(http://www.in.gov/idoa).
I affirm that I have made good faith efforts to select portions of the contract work to be
`
performed by WBEs, including, where appropriate, breaking out contract work items into
economically feasible units to facilitate WBE participation.
I affirm that I have made good faith efforts to solicit through all reasonable and available
means the interest of all WBEs 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
WBEs of contracting and subcontracting opportunities.
I affirm that I advertised in general circulation and/or trade association publications
concerning subcontract opportunities and allowed WBEs reasonable time to respond to
such advertisements.
I affirm that I performed any and all necessary steps to provide written notices in a manner
reasonably calculated to inform WBEs of subcontracting opportunities and allowed
l
sufficient time for WBEs to participate effectively.
�
I affirm that I followed up on initial solicitations with interested WBEs.
I affirm that I negotiated with interested WBEs in good faith, including providing such WBEs
with adequate information about the plans, specifications and other requirements of the
subcontract.
I affirm that I have made good faith efforts to assist interested WBEs in obtaining bonding,
lines of credit, or insurance as required by the City or the bidder, where appropriate.
Version 09/29/2021 Contractor's Bid for Public Works - 13
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM WBE-2.0
EVIDENCE OF GOOD FAITH EFFORTS
*Proper demonstration of Good Faith Efforts requires your initials next to all of the above boxes. Any
omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of
South Bend reserves the right to request additional information.
Version 09/29/2021 Contractor's Bid for Public Works - 14
I affirm that I have made good faith efforts to assist interested WBEs in obtaining
necessary equipment, supplies, materials, or related assistances or services, where
appropriate.
I affirm that I did not reject any WBEs as unqualified without sound business reasons
based on a thorough investigation of their capabilities.
CONTRACT RECORDS: The bidder has maintained the following records for each WBE 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 09/29/2021 Contractor's Bid for Public Works - 14
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE -2.1
( \ ' ==�a=
`~K8BECONTACTED
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-owned business meets the MBE qualifications. Attach additional pages if necessary.
PAGE OF
Project Number: 121'061R MBE Participation Goal
Project N Ward Bk Exterior
Bidder:
4 U J 0
Firm
Owner or Contact at MBE Firm M FC W-)- 1,
Telephone: 31 Fax:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OFCONTACT WITH THE MBE FIRM:
IVH
Owner or Contact at MBE Firm
Fax: Email:
Telephone: 61 56
TYPE OF WORK SOLICITED FOR THIS PROJECT:
If
Version 09/29/2021 Contractor's Bid for Public Works 15
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
woman -owned business meets the WBE qualifications. Attach additional pages if necessary.
PAGE OF
Project Number: 121-061R WBE Participation Goal
Project Name:
Bidder:
By:
(Signature)
WBE Firm
Ward Bakery Exterior Improvements
Owner or Contact at WBE Firm
(Title)
Telephone: Fax: Email:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
r2A S
(Date)
RESULTS OF CONTACT WITH THE WBE FIRM: i
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 09/29/2021 Contractor's Bid for Public Works - 16
CITY OF SOUTH BEND
I
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
r
%•
FORM MBE -2.1
,ecs
WBE 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
woman -owned business meets the WBE qualifications. Attach additional pages if necessary.
PAGE OF
Project Number: 121-061R WBE Participation Goal
Project Name:
Bidder:
By:
(Signature)
WBE Firm
Ward Bakery Exterior Improvements
Owner or Contact at WBE Firm
(Title)
Telephone: Fax: Email:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
r2A S
(Date)
RESULTS OF CONTACT WITH THE WBE FIRM: i
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 09/29/2021 Contractor's Bid for Public Works - 16
PART H
(For projects of $150,000 or more — IC 36-1-12-4)
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.)
I What public works projects has your organization completed for the period of one (1)
year prior to the date of the current bid?
Contract Amount
Class of Work
Completion
Date
Name and Address of Owner
E; -o5- OJ 0,
120
J
7 9 Z
�2',
1 A. R
1
20
V40rA
2. What public works projects are now in process of construction by your organization?
Contract Amount
Class of Work
Completion
Date
Name and Address of Owner
E; -o5- OJ 0,
J
7 9 Z
�2',
1 A. R
1
2-/J- 2_21
V40rA
1) r 1
3. Have you ever failed to complete any work awarded to you?MQ If so, where and
why?
4. List references from private firms for which you have performed work.
ZZ (-IJL C_2141/14 03R r
TSC 220060.04 Bid Form Section 00 3100-5
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, complete the project, number of workers, etc. and any
other information which you believe would enable the governmental unit to consider your
bid.)
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.
3. If you intend to sublet any portion of the work, state the name and addresses of each
subcontractor, equipment to be used by the subcontractor, and whether you will required 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. %
11, 1
TSC 220060.04 Bid Form Section 00 3100-6
4. What equipment do you have available to use for the proposed Project? Any equipment
used by subcontractors may also be required to be listed by the governmental unit.
=.
5. Have you 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
corroborate the process listed.
r
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 NON -COLLUSION AFFIDAVIT
The undersigned Bidder or agent, being duly sworn on oath, says that he has not, nor has any other
member, representative, or agent of the firm, company, corporation or partnership represented by
him, entered into any combination, collusion or agreement with any person relative to the price to
be bid by anyone at such letting nor to prevent any person from bidding nor to induce anyone to
refrain from bidding, and that this Bid is made without reference to any other bid and without any
agreement, understanding or combination with any other person in reference to such bidding.
He further says that no person or persons, firms, or corporations has, have, or will receive directly
or indirectly, any rebate, fee, gift, commission, or thing of value on account of such contract.
TSC 220060.04 Bid Form Section 00 3100-7
M. PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT
(a)
0) 0,11117 By checking this box, I hereby acknowledge that I am not a pre -qualified bidder
with the City of South Bend. the right to
By checking this box, I hereby acknowledge that the City reserves
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.
By checking this box, I hereby acknowledge that copies of all Applicable
Z
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)
---mnIndiana ofSbub�oon-Hnerecords (�.Bue�omever�cadon)dated within
u��a�
ohdy (60) days of the submission of said document showing that business is in
exietenoe, 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). Z,
Lost identifying all former business names.
����v��
/\nydmherminebonmbyacourtnrgovornrnerta|agencyanyviobtionooffedene|
7—�
state, or local laws including, but not limited to, violations of contracting or antitrust
laws, tax or licensing laws, environmental |axvo. Occupational Safety and Health
Act (OSHA), or federal Davis -Bacon andrelated Acts, within the preceding five (5)
s.
(iv) ' annw�� ��`/�Itaffing capabilities, including labor sources. This uhabamerd
--- indicates and ensures | have sufficient employees onstaff tocomplete the work |
anmbidding onQRoutlines how | intend tomeet the staffing needs ofthe work.
MGtatennentthat individuals who will performwork
---
behalf will be properly classified as an employee or as an independent contractor
under all applicable state and federal laws and local ordinances.
(vi) Forewarypo�act,submnbavidenoeofpa�cipationinappnent�nshipandtroining
--- applicable to the work to be performed on the project, which are
programs, epp .
approved by and registered with the United States Department of Labor's Office of
Apprenticeship, orits successor organization.
(vii)Copy of a written plan for employee drug testing that covers all of my employees
--- who will pedbnn work on the public work project and meats or exceeds the
requirements set forth in|C4'13-18-5or|C4-13-1O-G.
(viii)Evidence that ! mm utilizing u suretycompanywhich is on the Bureau ofFiscal
--'
Service "Department of Treasury's Listing of Approved Sureties" as required in the
bid specifications orcontract.
Version 10/13/2021 General Conditions -13
(») vvnoen statement of any federal, "a=`^ ,^c=.,a~.,~~~ .^,.`,^..,_~.
cies owr
to any federal, state or local taxing body in the preceding three years.
(i)�y Listufpnojectucfsinn}barsizmm
size mvy
a/�uv.ouov
---
the State of Indiana, within three (3) years prior to the date on which the bid is due.
(Print Name Here)
(Name of Company)
(Address of Company)
(Telephone Number)
Version 10/13/2021 General Conditions '14
J.W.WERNTZ & SON INC.
WERNTZ SUPPLY / WERNTZ GLASS
1002 KERR ST. SOUTH BEND M. 46601574-2324881, FAX 233-7051
12/13/2021
Proposal for Glass and Glazing
Project: WARD BAKERY
Attn.
PREQUAL CHECKLIST:
A. All boxes checked.
B. Attachments.i. secretary of state, ii no former business, iii no court actions, iv we have no labor
issues other than the obvious, v we are union glaziers, A we are union with a documented
apprentisechip program, vii we have a drug program, viii we are bonded,
Sincerely.
Patrick Werntz
y- APPROVED AND FILED
HOLLI SULLIVAN
INDIANA SECRETARY OF STATE
10/1512021 01:42 PM
BUSINESS ID 192606-040
BUSINESS TYPE Domestic For -Profit Corporation
BUSINESS NAME T W WERNTZ & SON INCORPORATED
ENTITY CREATION DATE 10/19/1927
JURISDICTION OF FORMATION Indiana
PRINCIPAL OFFICE ADDRESS 1002 KERR STREET, SOUTH BEND, IN, 46601, USA
YEARS
EFFECTIVE DATE
EFFECTIVE TIME
2021/2022
10/I5/2021
1:42 PM
REGISTERED AGENT TYPE Individual
NAME PATRICK SCOTT WERNTZ
ADDRESS 1627 E WASHINGTON ST, SOUTH BEND, IN, 46617 - 0000, USA
-Page 1 of 2 -
APPROVED AND FILED
HOLLI SULLIVAN
INDIANA SECRETARY OF STATE
10/15/202101:42 PM
"5'
P-
za, 2-1`11�11
NAME PATRICK SCOTT WERNTZ
ADDRESS 1627 E WASHINGTON, SOUTH BEND, IN, 46617, USA
TITLE
Vice President
NAME
Robert Wemtz
ADDRESS
25965 SR 23, South Bend, IN, 46614, USA
TITLE President
NAME PATRICK SCOTT WERNTZ
ADDRESS 1627 E WASHINGTON, SOUTH BEND, IN, 46617, USA
IN WITNESS WHEREOF, THE UNDERSIGNED HEREBY VERIFIES, SUBJECT TO THE PENALTIES OF PERJURY, THAT THE
STATEMENTS CONTAINED HEREIN ARE TRUE, THIS DAY October 15, 2021.
THE UNDERSIGNED ACKNOWLEDGES THAT A PERSON COMMITS A CLASS A MISDEMEANOR BY SIGNING A
DOCUMENT THAT THE PERSON KNOWS IS FALSE IN A MATERIAL RESPECT WITH THE INTENT THAT THE DOCUMENT
BE DELIVERED TO THE SECRETARY OF STATE FOR FILING.
SIGNATURE
TITLE
RONALD L FOUDY
CPA
Business ID: 192606-040
Filing NV: 9189931
- Page 2 of 2 -
i • • • i • i • f
t3cu ergA31OTM-2010
Conforms with The American institute of Architects AIA Document 310
Bid Band
CONTRACTOR:
t;'4`rrnre, Tegrr! 5tatrrr and rtdrli��ss}
J. W. Werntz & Son, Inc.
1002 Kerr St.
South Bend, IN 46601
OWNER:
f,'Vante, legal statics acrd address)
City of South Bend, Indiana
South Bend, IN 46601
SURETY:
/,3/rmre, legcrl.rtahtr rr�td principal place r f 1NtFIrtL'ss)
The Cincinnati Insurance Company
b2i Boa UH445250-5496
Mailing Address for Notices
BOND AMOUNT: $ 10% Ten Percent of Amount Bid
PROJECT:
(Xame, location or address andl'rofecttrumber, ifautj
Ward Bakery Exterior Improvements 121-061R
This document has important
legal consequences. Consultation
with an attorney is encouraged
with respect to its completion or
modification.
Any singular reference to
Contractor, Surety, Owner or
other party shall be considered
plural where applicable.
The Contractor and Surety are bound to the Owner in the amount set forth above, for the paymeat 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 tate Contractor within the time specified in the bid documents, or within such time period
as may be agreed to by the Owlicr and Contractor, and the Contractor either (1) caters into a contract with the Owner in accordance with
the terms ofsuch bid, and givos such bond or bonds as utak be specified in the bidding or Contract Documents, with a surety adin'incd in
the jurisdiction of the 1'rgicct 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 Oivncr may in good faith contract with another
party to perlbrm the work covered by said bid, then this obligation shall be null and void, otherwise to remain in Lull force and elleect. The
Surety hereby waives any notice oi'an agreement between the Owner and Contractor to extend the time in which the Owner may accept the
bid. "A aiver ol'notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time Ibr
acceptance ol'hids ;pe'ilied in the bid documents, and the Owner and Contractor shall obtain the Suret}'s consent lbr 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 shalt be deemed to be Contractor.
When this Bond has been tiirnished to comply with a statutory or anther legal requirement in the taxation ot'the Project, any provision in
this Band conflicting with said statutory or legal requirement shall be deemed deleted herefnim and provisions conlbnning to such
statutory or other legal requirement shall be deemed incorporated herein. When so Iiimished. the intent is that this Bond shall he construed
as a statutory bond and not as a common lain bond.
Signed and scaled this 14th day of December, 2021
Itl'itness) �'
flf'itne.%) David J. Roth
S-0054/AS 8110
J. W. VAerntz & Son, Inc.
(Fria f al) (Seal)
(Title)1 .l `i , �, �r�J i c,(,E A,'
The Cincinnati Insurance Company S,
ISurxt}j (Seal)
� caxraw�rs
S E A L
(Title) Tracie House Attorney -in- act0�00
THE CINCINNATI INSURANCE COMPANY
THE CINCINNATI CASUALTY COMPANY
Fairfield, Ohio
F;r#TjTJ4:7j-*
KNOW ALL MEN BY THESE PRESENTS: That THE CINCINNATI INSURANCE COMPANY and THE CINCINNATI CASUALTY
COMPANY, corporations organized under the laws of the State of Ohio, and having their principal offices in the City of Fairfield,
Ohio (herein collectively called the "Companies"), do hereby constitute and appoint Tracie House
its true and legal Attorney -in -Fact to sign and deliver on behalf of the Companies as Surety, at any place within the United States,
the following surety bond:
Surety Bond Number: Bid Bond
Principal: J. W. Werntz & Son, Inc.
Obligee: City of South Bend, Indiana
This appointment is made under and by authority of the following resolutions adopted by the Boards of Directors of The Cincinnati
Insurance Company and The Cincinnati Casualty Company, which resolutions are now in full force and effect, reading as follows:
RESOLVED, that the President or any Senior Vice President be hereby authorized, and empowered to appoint Attorneys -in -Fact
of the Company to execute any and all bonds, policies, undertakings, or other like instruments on behalf of the Corporation, and
may authorize any officer or any such Attorney -in -Fact to affix the corporate seal; and may With or without cause modify or
revoke any such appointment or authority. Any such writings so executed by such Attomeys-in-Fact shall be binding upon the
Company as if they had been duly executed and acknowledged by the regularly elected officers of the Company.
RESOLVED, that the signature of the President or any Senior Vice President and the seal of the Company may be affixed by
facsimile on any power of attorney granted, and the signature of the Secretary or Assistant Vice -President and the Seal of the
Company may be affixed by facsimile to any certificate of any such power and any such power of certificate bearing such
facsimile signature and seal shall be valid and binding on the Company. Any such power so executed and sealed and certified
by certificate so executed and sealed shall, with respect to any bond or undertaking to which it is attached, continue to be valid
and binding on the Company.
IN WITNESS WHEREOF, the Companies have caused these presents to be sealed with their corporate seals, duly attested by their
President or any Senior Vice President this 16th day of March, 2021.
THE CINCINNATI INSURANCE COMPANY
THE CINCINNATI CASUALTY COMPANY
STATE OF OHIO )SS:
COUNTY OF BUTLER
On this 16th day of March, 2021 before me carne the above-named President or Senior Vice President of The Cincinnati Insurance
Company and The Cincinnati Casualty Company, to me personally known to be the officer described herein, and acknowledged that the
seals affixed to the preceding instrument are the corporate seals of said Companies and the corporate seals and the signature of the
officer were duly affixed and subscribed to said instrument by the authority and direction of said corporations.
�ftIAL<<,.
%
-*-F Keith C e' Attorney at
La
u
Notary bli'� _ ate Ohio
St of io
Mycommission
o isslon has no exp ration date.
....... Section 147.03 O.R.C.
1, the undersigned Secretary or Assistant Vice -President of The Cincinnati Insurance Company and The Cincinnati Casualty Company,
hereby certify that the above is the Original Power of Attorney issued by said Companies, and do hereby further certify that the said
Power of Attorney is still in full force and effect.
Given under my hand and seal of said Companies at Fairfield, Ohio, this 14th day of December 2021
oma oxro
BN- I 457-S (3/21)
lx
1865
Date:
December 10, 2021
To:
All Planholders
From
Laura Hensley, Acting Clerk, Board of Public Works
Subject
Addendum Number: 1
Project Name: Ward Bakery Exterior Improvements
Project Number: 121-061R
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM
Date Received:
This addendum is being forwarded to you for the above referenced project.
Please sign below and acknowledge receipt of this Addendum
by faxing this sheet to the Board of Public Works at (574) 235-9171
within 48 hours of receipt. A copy MUST also be included with your
quote package upon submittal.
THIS ADDENDUM MAY AFFECT YOUR QUOTE.
Notes:
The attached documents are hereby added to the Specifications and Contract
Documents and become a part of herein.
Version 4/2/2019
Drug Testing Policy
JW Werntz is a drug-free workplace. As such, we prohibit the use of
nonprescribed drugs or alcohol during work hours. If the employee -comes to work under
the influence of drugs or alcohol or uses drugs or alcohol during work time, the employee
will be disciplined in accordance to the policy up to an including termination.
Under JW Werntz's drug testing policy, all current and prospective employees must
submit to the drug testing policy. Prospective employee's will only be asked to submit
to a test once a conditional offer of employment has been extended and accepted. An
offer of employment by JW Werntz is conditioned on the prospective employee testing
negative for illegal substances.
JW Werntz's policy is intended to comply with all state laws governing drug testing
and is designed to safeguard employee privacy rights to the fullest extent of the law.
Before being asked to submit to a drug test, the employee will receive written notice of
the request or requirements. The employee must also sign a testing authorization and
acknowledgement form confirming that he or she is aware of the policy and
employee's rights.
Any drug testing required or requested by JW Werntz will be conducted by a laboratory
licensed by the state. All expenses related to the test will be incurred by the company. The
employee may obtain the name and location of the laboratory that will analyze the
employee's test sample by calling laboratory 24 hours before the employee is scheduled to
be tested.
If the employee receives notice that the employee's test results were confirmed positive,
the employee will be given the opportunity to explain the positive result. In addition, the
employee may have the same sample retested at a laboratory of the employee's choice.
If there is reason to suspect that the employee is working while under the influence of
an illegal drug or alcohol, the employee will be suspended without pay until the results
of a drug and alcohol test are made available to JW Werntz by the testing laboratory.
Where drug or alcohol testing is part of a routine physical or random screening, there
will be no adverse employment action taken until the test results are in.
All testing results will remain confidential. Employee must sign a consent form prior to
the release of results. Test results may be used in arbitration, administrative hearings and
court cases arising as a result of the employee's drug testing. Results will be sent to
federal agencies as required by federal law. If the employee is to be referred to a
treatment facility for evaluation, the employee's test results will also be made available to
the employee's counselor.