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Home My WebLink AboutOpening of Bids - Ductile Iron Pipes, Valves and Hydrants Proj No. 122-023 - Ferguson WaterworksCITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK Project Name 2022 Ductile Iron Pipes, Valves and Hydrants Project No. 122-023 For Bids Due January 11, 2022, 9:00 a.m., Local Time PART (Must be completed for all bids. Please type or print) Date: ;IN„w.. 10,2622 Bidder(Firm): IN0.ACrf- eA$ Address: /O-li 011v4t Plow Cn..r1 City/State/Zip: _, t Zgyj /�J JW40t Telephone Number: ( 5714) Z%2-Z-SZ3 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: .- Pin a..l- -J� the City of South Bend, Indiana, in accordance with plans and specifications prepared by: 1 and dated JGnuaj., //y1t1� 2oZZ for the sum of (enter the Total Bid as shown on the Proposal) Twey y e-au,t-+ilnoN hds4hdSa e;ik6k In..Nd 'flw.INi a�d.5o,,.rN _ ($ Z8,IIZ01*1 ) (Enter gum of Total Base Bid plus'Alternates o— n Pr prr�„;�-- a.;AS (Numerical) The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the notice. Any addendums attached will be specifically referenced at the applicable page. If additional units of material included in the contract are 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 shown on a eparate attachment. BYtj t�-2c�....Lte.urt (Signature) (Panted Name of Person Signing) ACCEPTANCE The above bid is accepted this day of 20 Subject to the following conditions: BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Gary A. Gilot, Member Murray L. Miller, Member Joseph R. Molnar, Member Jordan V. Gathers, Member Attest: Clerk Version 09/29/2021 Contractor's Bid for Public Works - 2 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 11 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 09/29/2021 Contractor's Bid for Public Works - 3 vea u < BID/PROPOSAL CITY OF SOUTH BEND Project Name: 2022 Ductile Iron Pipes, Valves and Hydrants Project Number: For Bids Due: Contractor Name: 122.023 January 11, 2022, 9:00 a.m., Local Time Division 1 Item No. Description Quantity Unit Unit Price Total 1 4" X 18' Ductile Iron Pipe 1 EA q-11.-70 $ 419 i0 2 6" X 18' Ductile Iron Pipe 1 EA 3(.-1'0-L $ 3(01.O -L 3 8" X 18' Ductile Iron Pipe 1 EA 4 -5(0 $ 4013,5(P 4 10" X 18' Ductile Iron Pipe 1 EA (o3S $2 $ (038, 82 5 12" X 18' Ductile Iran Pipe 1 EA %14.14 $ 8114. I'{ 6 16" X 18' Ductile Iron Pipe 1 EA 119 1.62 $ ou,(02 7 20" X 18' Ductile Iron Pipe 1 EA 151�.I10 $ ( S'Il (b 8 24" X 18' Ductile Iron Pipe 1 EA 1995.48 $ 1995.4$ 9 30" X 18' Ductile Iron Pipe 1 EA 274- 12 $ Z-1 (4-Z.IZ Division 1 Total P( 2 Division 2 10 4" Open Right, MJ* valve 1 EA 515.42 $ 5615,y'Z 11 6" Open Right, MJ valve 1 EA 7(07ZSO $ -7 (07. 5D 12 8" Open Right, MJ valve 1 EA Il go. 12 $ 180 It 13 10" Open Right, MJ valve 1 EA I glol I� $ 1819. 18 14 12" Open Right, MJ valve 1 EA 3o3.fo5 $ 23°3.loS Division 2 Total *4,(0(40.%-7 Division 3 15 5.25" SB Fire Hydrant, 5 FT 1 EA 22-I28i $ Z.2-12.11-1 16 5.25" SB Fire Hydrant, 5.5 FT 1 EA Z321 -110 $ 2321 ieo 17 5.25" SB Fire Hydrant, 6 FT 1 EA 2310,(oL $ 237p,(0(0 Version 09/29/2021 Contractor's Bid for Public Works - 7 18 5.25" SB Fire Hydrant, 6.5 FT �pt id EA Z jq 5V $ 2'i 11. 5(* 19 BID/PROPOSAL 1 EA CITY OF SOUTH BEND $ 2y 118.yS Project Name: 2022 Ductile Iron Pipes, Valves and Hydrants ew... Project Number: 122-023 For Bids Due: January 11, 2022, 9:00 a.m., Local Time Contractor Name: Yq�<a . Gv 013NWeA t 18 5.25" SB Fire Hydrant, 6.5 FT 1 EA Z jq 5V $ 2'i 11. 5(* 19 5.25" SB Fire Hydrant, 7 FT 1 EA (0$ yS $ 2y 118.yS Division 3 Total olu53.3o, 'Mechanical Joint (MJ) DIVISIONS 1-3 COMBINED: 1$28, uo.79 Bidder (Firm): .F-ef%AS!Qn Wa��rdwarlcS Address: tori Ojiwc Ph� C,,vt- City/State/Zip: Sn,,.;i /t! K(aOcN Telephone Number: ( 5-7q) 232-2.3Z3 By � Y .- (Signature) Di?viv� 110Nv of (Printed Name of Person Signing) Version 09/29/2021 Contractor's Bid for Public Works - 8 When theprospective Contractor is unable to certify to any of the statements below, it shall attack 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 h 1,qN ) SS: 5osedn COUNTY ) The undersigned Contractor, being duly swom 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. 4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the Contactor subsequently learns is an unauthorized alien. Version 09/29/2021 Contractor's Bid for Public Works -4 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 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 (")TVBE") 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 WEE 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. 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 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 %Q+� day of -4 4oly, 20zz rem, -<o,,. Wo%+,erL. at,i 5 ConBidder (Firm) Signature o Contractor/Eidder or Its Agent F�Qv%v\ 11Jju r — ezmi c:-% (MGrnN� ('- Printed Name and Title Subscribed and sworn to before me this J D* day ofJ�'�/ �A, /'20� My Commission Expires D l I a� zq ,I Q A,AL l7 kt46,tWLaA Notary Public County of Residence S-E-�� Version 09/29/2021 Contractor's Bid for Public Works - 6 CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK RESPONSIBLE BIDDER CHECKLIST Project Name 2022 Ductile Iron Pipes, Valves, and Hydrants Project No. 122-023 For Bids Due January 11, 2022, 9:00 a.m., Local Time Contractor Name: {'�tiSn Ww�Pc wo(�GS 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 If 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 31s' 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 10/13/2021 General Conditions - 10 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 10/13/2021 General Conditions - 11 PRE -QUALIFIED BIDDER CHECKLIST (a) Acknowledgements: (i) _ 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. 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) _ 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) _ 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) _ 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) _ 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 10/13/2021 General Conditions - 12 11. 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 7— request supplemental information, additional verification of any information provided, and may also conduct random inquiries of my current and prior customers. The City reserved the right to utilize all information provided in this submission and all information obtained in inquiries or requests to determine if a bidder is responsive and responsible. Additionally, I acknowledge that all information provided to the City shall be regarded as public records. (iii) By checking this box, I hereby acknowledge that copies of all Applicable apprenticeship certificates or standards for training programs applicable to the work performed on the project may be requested at any time and shall be furnished upon request. (iv) By checking this box, 1 hereby acknowledge and ensure that I and all sub- contractors, from whom I have accepted a bid and/or intend to hire to perform work on the public work project, are properly licensed. Furthermore, I acknowledge my understanding that it is my responsibility to ensure that all sub -contractors have the necessary licenses to undertake the work called for in this bid. If a sub- contractor loses their license at any point, it is the responsibility of that sub- contractor to notify the City. (b) Attachments, (i) ✓ Indiana Secretary of State's on-line records (ie. Business verification) dated within sixty (60) days of the submission of said document showing that business is in existence, current with the Indiana Secretary of State's Business Entity Report, and eligible for a certificate of good standing. (Not applicable to individuals, sole proprietors or partnerships). (ii) _ List identifying all former business names. (iii) _ Any determinations by a court or governmental agency any violations of federal state, or local laws including, but not limited to, violations of contracting or antitrust laws, tax or licensing laws, environmental laws, Occupational Safety and Health Act (OSHA), or federal Davis -Bacon and related Acts, within the preceding five (5) years. (iv) _ Statement about staffing capabilities, including labor sources. This statement indicates and ensures I have sufficient employees on staff to complete the work I am bidding on OR outlines how I intend to meet the staffing needs of the work. (v) _ Statement that individuals who will perform work on the public work project on my behalf will be properly classified as an employee or as an independent contractor under all applicable state and federal laws and local ordinances. (vi) _ For every project, submit evidence of participation in apprenticeship and training programs, applicable to the work to be performed on the project, which are approved by and registered with the United States Department of Labor's Office of Apprenticeship, or its successor organization. (vii) _ Copy of a written plan for employee drug testing that covers all of my employees who will perform work on the public work project and meets or exceeds the requirements set forth in IC 4-13-18-5 or IC 4-13-18-6. (viii) _ Evidence that I am utilizing a surety company which is on the Bureau of Fiscal Service "Department of Treasury's Listing of Approved Sureties' as required in the bid specifications or contract. Version 10/13/2021 General Conditions - 13 (ix) Written statement of any federal, state or local tax liens or tax delinquencies owed to any federal, state or local taxing body in the preceding three years. (i) ✓ List of projects of similar size and scope of work performed in all areas, including the State of Indiana, within three (3) years prior to the date on which the bid is due. Date: QhvLkv,.i ID4t". 2o2 (Sign Here) Z)�tJ'h fV UVPJ (Print Name Here) �2CAu5vi.. Way-4err.�.ac�-S (Name of Company) loll Ojiver 1"10w (Address of Company) So 14. a"d (City) (State) 051q) 282-77 (Telephone Number) Version 10/13/2021 General Conditions - 14 To Whom It May Concern; Effective March 31, 2019, Ferguson Enterprises, Inc. became Ferguson Enterprises, LLC (Ferguson). Asa result of the name change, we would like to provide you with the most recent W-9 Form attached for your records,. This change for Income tax purposes requires the corporate income taxfrom the LLC to -be reported under the parent company, now Ferguson US Holdings Inc (FUST). As.a result of this change all federal documents, like W -9's and 1099s etc., are required to follow this rule and therefore, will show the parent company. At the time of the entity conversion Wolseley Investments Inc (Wil) Was Fergusons: parent company. Because ofthisfederal W-9 requirement it was determined that we should also change the parent company name to Ferguson US Holdings Inc, for consistency when providing W -9's to vendors, Effective May 2019, we changed the name of WII to Ferguson US Holdings. Contracts and exemption certificates may still be under Ferguson Enterprlses LLC since that Is the company doing the business, however we are unable to provide a W-9 thatshows Ferguson as the company on line 1with the corresponding.ElN. We can provide other backup from the IRS identifying Ferguson Enterprises LLC and its corresponding. EIN of 544211771. %Pleasefind.attached'a copy of the IRS confirmation letter for Ferguson Enterprises LLC and its EIN. In addition, the W-9 does provide a section for disregarded entities & DBA's on line which we have entered Ferguson Enterprises LLCto show the relationship. If you have any questions, please feel free to contact me at ienWer:nabon,@fereuson.corn or 757-228- 6891 -- Regards, j �Q Zia L4 dAn 1vol Jennifer Fabs on " Indirect Tax Manager ferguson Enterprises tLC 0 FERGUSON VSPP.Jer(emon Avenue wwjno&News. VA 33602 Phone )7577) 879.7795 9ldegtificatl Request for Tax Glue Farm to tn a Farm (Rev, 0alobar2818) n Number and d Certification requester. l3onof Aspan mentd0ra7raaaary telernal Pevanue`Ssrvlae rGo io,OwW:frs:goy/Form W9f6rinstYnations endiho latest Information. Send ta4ha3RS; _ 1 Name(atshown on your Income bog return).Name Is required on this line;donot leave this line blenk.- Ferguson '11S Holdings,1no, 2 Business name/dleregsrded evilly, nems, If dliferent.from-above Ferguson Enterprises, LLG 0 Oheolt appropnatebox for federaladd otasalfloatian of the person Whose name 14 entered on One` 1, 01heckaMy one 6fthe 4 Exemptions (codas apply only to M I01loWlpg-oven boxes, certain entities, not lndlvlduals� sea a o ❑ Indlvlduayeole proprietor or d CCorporatiop El Carp station Q -:Partnership ❑YrusVeslete Inlmoticnean pages);. c smgfe-megiber LLC Exemptpriyee codeOf any) 5 0 Ilmlted{lability company, Enter ihe Vox classification (Cc corporalloa, s -S corp6ratlan, P=Parinsrsirlp).► p 2 Note:Chockthe appropriate boxinjhe line abovalorthe WKClassllloatlon of lhealhglevnsmbsr owner. Oonotchook ExempllonfmmFATCAtepoding. +'Te LLC lithe LI -Cls classified asasingle-mamber LLCthath; disregarded Irani the owner unless the ownerofth"L.0 Isanother LLC that I"ot disregarded fromtheowner(ar U.s, federal her purposes,Otherwise, as(nglA-(namber I -W that Dods Of any) E. a is. disregarded Unlothe owner ehauld ohechthe Appropriate.bag for the.tax -classillcationoftls owner, _ ❑ Olhar loss Instructions) i-_ (ePP+k iaeccdunl+mvMiatmdwNb8lA+aaj: y -Address (number, S,tee{, and apt, rnsu_Ile no ,j See Instructions, Paquastafshome and Address(opganal) 12600 Jefferson Avenue 0 CRY. datep and ZIP code Newport.News, VA 23662 7 Ltekaocount nurnw(s):hero (optisnal) Taxpayer Identification Number (TIN) Enter your TIN In the appropriate box, The TIN provided must match the name glven an line 1 to avoid. 560101 security fors numb s ctlons number , late . However, eerily, seer a Inst vedurns.for6ert h Iater..:For wever, backup e,sleop ietor, or this this Is generally your a the resident alien, sola withholding, FbArtrOvIdu la, this r 'm _ entf8as, it Is your employer iderti laation ntrmlbst-je �. If you do not have a number, sea Now to gei a . .TIN, later; - - _ or Note; If account is In more than one name, ee9:the Instructions ler line 1. Also see What Name and LEI NumWToo aNe•the Requesterfor guidelines on whose numberp enter, S, tans a. U;S, citizen or other U,% person I am exempt from FATCA reparAng Is oorrect. algn signature of(� s--. Here U:S.oarsont: 11�..--+ �- beta R'3. 1 '13 General Instructions Section references sre lathe Internal RayenUo Code dtlless otherwise noted, Future developments. For the latest information about chwalopments: related 10 Form VN -9 and Its,Instruotlans, such as Iaglslailo t enacted After they, were published, Re to WWW/rs.pov/FoimW9,. Purj ose,of Form An IndiVldual or entity (Form W-9 requaster),Who Is required to flWal) Information relum Wlth the IRS.muat obtain your correct teXpayer Itlentilicatlbn ti4mbar (TIN) which may be your social seeurhY-humber. (S5N), IndlvkW taxpayer Ideir""catlan number (ITIN), adoption tax yr ae Identlitcatlon nuntber:(ATIN), or employer Idenllflcatlon number Celt0), to repoI an an InfoYrt)etlon return the amount paid tt>;yau; or other amount reportable on an Informallon relurn.Examples of Information Yalumstri'ludo, but are not limited'to, iheyollovjtn8 . Form 1099 -INT (Interest earned or paid). 313(8 IFtavenue me that I am because + Form 1099 DIV (dlvldend% molddtl d those front stocks6r.mutpal funda) • Form 1099-M,ISO (varlous types of lncoine, prizes., awardso.Y.gross proceeds) e Farm 9099-13 stookor mutual fund sales and aardoln othor traneactlans by brokers) + Form 10095 (pfoceeds from real'.: Wile trdn tgoo.ons) •-Fonrh 10004( (maronant card and third party n'etworlt trohsagt(bns) + Form 1090 (hotnsaicrtgage Interest), I o90' -E (student loan Interest),: 1098-T (tuitlon) • Form IM -0 (oonceled debt) + Form 1690A (acquisltion or aband6nmant of seoured properlyy' Use -Form W-0 only If you area UA peraon (Including a resident -allan),:to provide your aorraotTIN, 1t yoV do nal retuin:Fom) W-9 la-thetequester With a TIN, yau:ri7lght be anti/echo paoNupWlthholdipg, See What Is backup withholding,. i•,<r -- .Cat, 1`10,:10291X Farm W49 (Rau, 10-20`18) Ferguson Enterprises, LLC utilizes the following IJBA names: Current and :.Former dba Names .Entity Name Action Automation, a Wolseley Industrial Group company Action Plumbing Supply: _ Action Supply, Co. AOL Alaska Pipe& Supply Andrews Lighting& Hardware Gallery BAC Appliance Center Bath r beyond Blackman Plumbing Supply Bruck-Mevey 9ruce-Rogers Company Gal -Steam Capital Distributing, CFP City Lights DesignShowroom. One ContractSales Custom Lighting& Hardware Davies. Water Dealerriet Duhlg Stainless Equarius Waterworks, Meter & Automation Group Factorybirect Appliance Ferguson Bath & Kitchen Gallery Ferguson Bath, Kitchen & Lighting Gallery Ferguson Direct Ferguson Enterprises of Virginia, LLC Ferguson FacllltiesSupply (FEI) Ferguson Heating & Cooling Ferguson Hospitality Sales _ Ferguson. HVAC Ferguson HVAC -Au Cold Fergusbn HVAC -EastWest AIr Ferguson HVAC -Lyon Conklin Ferguson.lntegrated Services- _ Fef9uson International Ferguson Parts & Packaging Ferguson Valve:&Automation Ferguson Waterworks Ferguson Waterworks- MuniclpaFPipe. Ferguson Waterworks- Reif Hed. 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['911 ,IPV I1r7flow tIII tllt Oft I)(ItIor, vil rtilnUl'ar I 1.`Ni.IN it 11 thA!I 14)-1INtU BUSINESS INFORMATION CONNIE LAWSON INDIANA SECRETARY OF STATE 11/23/2020 11:10 AM Business Name: FERGUSON ENTERPRISES, LLC Business ID: 198403-760 Entity Type: Foreign Limited Liability Company Creation Date: 03/21/1984 Principal Office Address: 12500 Jefferson Ave., Newport News, VA, 23602, USA Jurisdiction of Formation: Virginia Business Status: Active Inactive Date: Expiration Date: Perpetual Business Entity Report Due 03/31/2022 Date: Original Formation Date: 01/01/1800 Years Due: Title Name Address Manager Kevin M. Murphy 12500 Jefferson Ave, Newport News, VA, 23602, USA Manager With= S. Brundage 12500 Jefferson Ave, Newport News, VA, 23602, USA Manager Alex B. Hutcherson 12500 Jefferson Ave, Newport News, VA, 23602, USA Manager Ian T. Graham 12500 Jefferson Ave, Newport News, VA, 23602, USA President & Chief Executive Officer Kevin M. Murphy 12500 Jefferson Ave, Newport News, VA, 23602, USA Chief Financial Officer William S. Brundage 12500 Jefferson Ave, Newport News, VA, 23602, USA Chief Operating Officer Alex B. Hutcherson 12500 Jefferson Ave, Newport News, VA, 23602, USA Senior Vice President & Secretary Ian T. Graham 12500 Jefferson Ave, Newport News, VA, 23602, USA Treasurer Brenda L. Crowder 12500 Jefferson Ave, Newport News, VA, 23602, USA Assistant Secretary James L. Cooper 12500 Jefferson Ave, Newport News, VA, 23602, USA Assistant Secretary Eric A. Gallo 12500 Jefferson Ave, Newport News, VA, 23602, USA Assistant Secretary Wesley E. Rice 12500 Jefferson Ave, Newport News, VA, 23602, USA Assistant Secretary Julie A, Yutesler 12500 Jefferson Ave, Newport News, VA, 23602, USA Type: Business Commercial Registered Agent Name: CORPORATE CREATIONS NETWORK INC. Address: 8520 Allison Pointe Blvd #220, Indianapolis, IN, 46250, USA IN R JC-v�y'1Txy CERTIFICATE OF FACT 1 Cert the Following from the Records of the Commission: That Ferguson Enterprises, LLC is duly organized as a limited liability company under the law of the Commonwealth of Virginia; That the limited liability company was formed on March 31, 2019; and That the limited liability company is in existence in the Commonwealth of Virginia as of the date set forth below. Nothing more is hereby cert feed. Signed and Sealed at Richmond on this Date: November 4, 2020 CERTIFICATE NUMBER: 2020110415117628 1316 CoUNTY-Crry BUILDING 227 W. JEFFERSON BOULEVARD SOI rrH BRND. INDIANA 46601-1830 Devin Nuner Ferguson Waterworks 1077 Oliver Plow Court South Bend, IN 46635 CITY OF SOUTH BEND PETE BUTtIGIEG, MAYOR BOARD OF PUBLIC WORKS April 9, 2019 PHONE 574/235.9251 FAR 57V 235-9171 RE; Award Bid— 2019 Street and Sewer Department Materials — Project No. 119-008 Dear Nuner: The Board of Public Works, at its meeting held on April 9, 2019, awarded the above referenced bid to the following, in the amount of unit prices. Your award will be listed in bold print. a) Rieth Riley Construction Co., Inc.; Division A, C-1, C-3 b) Ozinga Ready Mix, Division B c) Klink Trucking, Inc.; C-2, C4, C-6 d) Ferguson Waterworks; Division D, G-1, G-2, G-3 e) American Highway Products; Division E f) SealMaster Indianapolis; Division F g) Bit -Mat Products of Indiana, Inc.; Division I Bids for Line Items C-5, G-4, G-5, G-6, and G-7 were rejected and no bids were received for Divisions H and J. A representative from the Public Works Department will contact you regarding the bid award Please call this office with any questions regarding this matter at (574) 235-9251. Sincerely, yY/� Linda M. Martin, Clerk Enclosure GARY A. GILOT GENEVIEVEE. MILLER ELIZABETH A. MARADIK LAURA L. O'SULLIVAN THERESEJ.DORAU Timothy Neese Mayor NOTICE OF BID AWARD March 26, 2019 Ferguson Waterworks 1077 Oliver Plow Court South Bend, IN. 46601 Board of Public Works 229 S. Second St. Elldwt, IN 46516 RE: BID #19-01 Utility Materials You were awarded the above Bid #19-01 on February 19, 2019 by the Board of Public Works per the enclosed bid tab memo. After the Board of Works signs the Contracts, we will return an original to you for your file. Thank you. Sincerely, W F PUB WORKSils dministrative Assistant Enc: Bid Tab Award Memo, Bid Bond, Contracts 574.294.5471 Pax: 574.522.6794 CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK CHECKLIST FOR BIDDERS Project Name 2022 Ductile Iron Pipes, Valves and Hydrants Project No. For Bids Due 122-023 January 11, 2022, 9:00 a.m., Local Time �4�UTHR d yasa;� 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 MNVBE 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 MNVBE Contacted Forms [MBE -2.1 and WBE-2.1]. Acknowledge Receipt of 81, Addendum(s) included with the bid. 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. t/ 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. s�. Bidder: FetauoUVaif(`W6A3 Date: �nNHavu_ 10.2A2Z By Authorized Representaxive: Signature: Print Name & Title: Version 09/29/2021 Contractor's Bid for Public Works - 1