Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Opening of Bids - 2022 Curb and Sidewalk, Round I Proj No. 122-001 - Premium Concrete Services, Inc.
CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK Project Name 2022 Curb and Sidewalk Construction —Round 1 Project No. For Bids Due 122-001 July 121h, 2022 PART (Must be completed for all bids. Please type or print) Date: *1,21,2/�2Bidder (Firm): Address: %�� ;u -,n'o'r wa ST City/State/Zip: [LKNRRiyTiJ q(,ISV4 Telephone Number: (57N ) o26 Y-019 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: 2022 Curb and Sidewalk Construction — Round 1 the City of South Bend, Indiana, in accordance with plans and specifications prepared by: of South Bend Division of and dated Wfl.zZ for the sum of (enter the Total Bid as shown on the Proposal) TNa,F,s *Wj9xZD n0vey-7 0X_YA&". ,0D SsX /kWORCD Csr, ?Y-F=oE ($ 393/ 68S ) (Enter sum of Total Base Bid plus Alternates shown on Proposal) (Numerical) The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the notice. Any addendums attached will be specifically referenced at the applicable page. If additional units of material included in the contract are 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 separate attachment. By Sgnature) Rob 3� (Printed Name of Person Signing) The above bid is accepted this Subject to the following conditions: BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Gary A. Gilot, Member ACCEPTANCE day of 20 Joseph R. Molnar, Vice President Jordan V. Gathers, Member Murray L. Miller, Member Attest: Theresa Heffner, Clerk Version 09/29/2021 Contractor's Bid for Public Works - 2 BIDIPROPOSAL CITY OF SOUTH BEND Project Name: 2022 Curb and Sidewalk Construction— Round 1 Project Number: 122-001 For Bids Due: July 121", 2022 Contractor Name: P46MrUel C0A)e—XETT_ 5EKLACCR3 nnncinN 1 Item No. Description Cty Unit Unit Price Total Amount 1 CONCRETE SIDEWALK, REMOVE 800 SY 2 CONCRETE SIDEWALK, 4 -IN 860 SY 3 CONCRETE CURB, REMOVE 1585 LF 4 CONCRETE CURB, MODIFIED 1595 LF 5 CONCRETE APPROACH, REMOVE 98 6 GRAVEL APPROACH, REMOVE 86 r-Sy 7 ASPHALT APPROACH, REMOVE 37 8 PCCP FOR APPROACHES, 6 -IN 252 9 CURB RAMP, REMOVE 49 SY 10 ONE-WAY PERPENDICULAR CURB RAMP 13 SY 11 PAIRED PERPENDICULAR CURB RAMP 40 SY 12 TOPSOIL AND SEEDING 1070 SY 13 TREE, REMOVE, 18 -IN 4 EA 14 TREE, REMOVE, 30 -IN 3 EA 15 STUMP, REMOVE 4 EA 16 PLANT, DECIDUOUS TREE, SINGLE STEM, 2 -IN TO 2.5 -IN 23 EA DIVISION 1 TOTAL � V bm Version 09/29/2021 Contractor's Bid for Public Works - 7 BID/PROPOSAL ylr CITY OF SOUTH BEND _ Project Name: 2022 Curb and Sidewalk Construction — Round 1 Project Number: 122-001 For Bids Due: July 121h, 2022 Contractor Name: FU?!tZme l e0AJG1ZE7r_ 9109 rXZ5 DIVISION 2 Item No. I Description oty Unit Unit Price Total Amount 1 CONCRETE SIDEWALK, REMOVE 300 SY 2 CONCRETE SIDEWALK, 4 -IN 330 SY 3 CONCRETE CURB, REMOVE 1105 LF 4 CONCRETE CURB, MODIFIED 1110 LF 5 CONCRETE APPROACH, REMOVE 34 SY 6 GRAVEL APPROACH, REMOVE 31 SY 7 BRICK APPROACH, REMOVE 12 SY 8 PCCP FOR APPROACHES, 6 -IN 81 SY 9 CURB RAMP, REMOVE 77 SY 10 ONE-WAY PERPENDICULAR CURB RAMP 30 SY 11 PAIRED PERPENDICULAR CURB RAMP 47 SY 12 TOPSOIL AND SEEDING 485 SY 13 TREE, REMOVE, 30 -IN 1 EA 14 STUMP, REMOVE 4 EA 15 PLANT, DECIDUOUS TREE, SINGLE STEM, 2 -IN TO 2.5 -IN 7 EA DIVISION 2 TOTAL NO Uhf) Version 09/29/2021 Contractor's Bid for Public Works - 8 BIDIPROPOSAL CITY OF SOUTH BEND Project Name: 2022 Curb and Sidewalk Construction — Round 1 Project Number: ( 122.001 For Bids Due: July 121^, 2022 Contractor Name: REMsorAl 41464Erif 5;Cea=c,4-5 nivicinnl n Item No. Description Oty Unit Unit Price Total Amount 1 CONCRETE SIDEWALK, REMOVE 175 SY pb 7,3 5Z), o� 2 CONCRETE SIDEWALK, 4 -IN 175 SY 7300 /Z 77S o0 3 CONCRETE CURB, REMOVE 450 LF 0C> dC> 4 CONCRETE CURB, MODIFIED 450 LF DO %O 2re e� 5 CONCRETE APPROACH, REMOVE 15 SY 3S ay bZjr� 6 BRICK APPROACH, REMOVE 14 SY 7 PCCP FOR APPROACHES, 6 -IN 30 SY 125-,45 0 '250 4 8 TOPSOIL AND SEEDING 190 SY , 15�0 9 TREE, REMOVE, 30 -IN 1 EA �rgp,64 �BQp DIVISION 3 TOTAL *6e 14�) 0 00 Version 09/29/2021 Contractor's Bid for Public Works - 9 nruminnl e Item No. Description City Unit Unit Price Total Amount 1 CONCRETE SIDEWALK, REMOVE BID/PROPOSAL Sy (�gO CITY OF SOUTH BEND CONCRETE SIDEWALK, 4 -IN 640 Project Name: 2022 Curb and Sidewalk Construction - Round 1 y(� %,20 3 Project Number: 122-001 LF Z5 For Bids Due: July 12°i, 2022 CONCRETE CURB, MODIFIED 205 Contractor Name: CeNci4ETe 5ERaZ::�S �22s 5 nruminnl e Item No. Description City Unit Unit Price Total Amount 1 CONCRETE SIDEWALK, REMOVE 645 Sy (�gO 2 CONCRETE SIDEWALK, 4 -IN 640 Sy % j y(� %,20 3 CONCRETE CURB, REMOVE 205 LF Z5 4 CONCRETE CURB, MODIFIED 205 LF yj �22s 5 CONCRETE APPROACH, REMOVE 31 SY 6 GRAVEL APPROACH, REMOVE 12 Sy 7 PCCP FOR APPROACHES, 6 -IN 47 Sy 8 CURB RAMP, REMOVE 16 Sy 9 PAIRED PERPENDICULAR CURB RAMP 21 SY tae 3 ggs 10 TOPSOIL AND SEEDING 855 Sy 7yD 11 TREE, REMOVE, 10 -IN 1 EA OOp - X5 m 12 TREE, REMOVE, 18 -IN 3 Sap 13 TREE, REMOVE, 30 -IN 5 CI gam ' L CO 14 TREE, REMOVE, 48 -IN 2 jEA G� Cl7l� 0 &x, eto15 STUMP, REMOVE 2 g� / 16 PLANT, DECIDUOUS TREE, SINGLE STEM, 2 -IN TO 2.5 -IN 23 EA ) na oQ7 o0 0?3 �p DIVISION 4 TOTAL Version 09/29/2021 Contractor's Bid for Public Works - 10 tiO�t U� BID/PROPOSAL CITY OF SOUTH BEND`` Project Name: 2022 Curb and Sidewalk Construction – Round 1 Project Number: 122-001 For Bids Due: July 12th, 2022 Contractor Name: P!{FJ�7iGt.�7 C pN4lE7L �E2 ✓L� t5 nivicirinl e Item No. Description Qty Unit Unit Price Total Amount 1 CONCRETE SIDEWALK, REMOVE 325 SY y2= 1316.50 m 2 CONCRETE SIDEWALK, 4 -IN 325 SY %�j�. �✓ %m 3 CONCRETE CURB, REMOVE 605 LF 4 CONCRETE CURB, MODIFIED 605 LF 7 -7.75-`t' 5 CONCRETE APPROACH, REMOVE 23 SY%.2?5T 3 %b5�`�' 6 GRAVEL APPROACH, REMOVE 16 SY / u� o0 7 BRICK APPROACH, REMOVE 13 SY 690 8 PCCP FOR APPROACHES, 6 -IN 42 SY S;S'p p' 9 TOPSOIL AND SEEDING 345 SY 0� p 35p'� 10 TREE, REMOVE, 18 -IN 5 EA rq7 7 5.60 iso 11 TREE, REMOVE, 30 -IN 3 EA O� � ao Z a-� 12 TREE, REMOVE, 48 -IN 2 EA S� `� 6� a� 13 PLANT, DECIDUOUS TREE, SINGLE STEM, 2 -IN TO 2.5 -IN 14 EA / Oct � r! t� � Bidder (Firm): Address: DIVISION 5 TOTAL &79&Vi / prursr�s 3- S GRAND TOTAL X393. (o$S //Lt�7 l-.OnJcRET,E SERurp�S 70/ rch4koojQ 5-1— City/State/Zip: -1— City/State/Zip: ,ELI<4s?RTrNy(oiiOTelephoneNumber: (57i/) By (Signature) X03 G'E�EK (Printed Name of Person Signing) Version 09/29/2021 Contractor's Bid for Public Works - 11 �o�spU1'H. Bg�. fi F` CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK CHECKLIST FOR BIDDERS Project Name 2022 Curb and Sidewalk Construction — Round 1 Project No. For Bids Due 122.001 12", 2022 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 _A— 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. This checklist submitted with the Bid. This checklist is provided for bidder's use in assuring compliance with required documentation; however, it does not include all specifications requirements and does not relieve the bidder of the need to read and comply with the specifications. / Bidder: 6A)eA6t.E 5FX0,ncX5 Date: By Authorized Representa�iv7� Signature: Print Name & Title: X0,3 6& K,Ie M 5,E1r0,0\ CS 7% rwf)10/t Version 09/29/2021 Contractor's Bid for Public Works - 1 �SpY7'I'H UE'IIv o'd 1316 COUNTY-CrTv BUILDING PHONE 574/235-9251 227 W. JEFFERSON BOULEVARD z. iR[u, yr"FAX 574/235-9171 SOUTH BEND, INDIANA 46601-1830 TDD 574/ 235-5567 CITY OF SOUTH BEND, JAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS Date: July 8, 2022 To: All Planholders From Theresa Heffner, Clerk, Board of Public Works Subject Addendum Number: 1 Project Name: 2022 Curb and Sidewalk Round 1 Project Number: 122-001 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: -7191.22— This 71B12.Z This addendum is being forwarded to you for the above referenced project. Please sign below and acknowledge receipt of this Addendum by faxing this sheet to the Board of Public Works at (574) 235-9171 within 48 hours of receipt. A copy MUST also be included with your bid package upon submittal. THIS ADDENDUM MAY AFFECT YOUR BID. Notes: The attached documents are hereby added to the Specifications and Contract Documents and become a part of herein. Company: f RE/�?lcti+'J Cfa1vC/1['TE 5e4or-cE5 Authorized Signature: Date: Version 4/2/2015 w'=AIA DOCu meiM A31 OTM -2010 CONTRACTOR: (Name, legal status and address) Premium Concrete Services, Inc. 712 Richmond St SURETY: (Name, legal status and principal place of business) Old Republic Insurance Company P. O. Box 0941 Elkhart, IN 46516 Brookfield, WI 53008-0941 OWNER: (Name, legal status and address) City of South Bend Board of Public Works County -City Building Room 1316 South Bend, IN 46601 BOND AMOUNT: Five Percent of the Total Bid 5% of Total Bid PROJECT: (Name, location or address, and Project number, if any) 2022 Curb and Sidewalk Construction - Round 1; Project No. 122-001 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 payment of which the Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, as provided herein. The conditions of this Bond are such that if the Owner accepts the bid of the Contractor within the time specified in the bid documents, or within such time period as may be agreed to by the Owner and Contactor, and the Contractor either (1) enters into a contract with the Owner in accordance with the terms of such bid, and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a surety admitted in the jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof; or (2) pays to the Owner the difference, not to exceed the amount of this Bond, between the amount specified in said bid and such larger amount for which the Owner may in good faith contact with another patty to perform the work covered by said bid, then this obligation shall be null and void, otherwise to remain in frill force and effect. The Surety hereby waives any notice of an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for an extension beyond sixty (60) days. If this Bond is issued in cormection with a subcontractor's bid to a Contactor, the tetra Contactor in this Bond shall be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor. When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the Project, any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein. When so furnished, the intent is that this Bond shall be construed as a statutory bond and not as a common law bond. Signed and sealed this 7th day of July 2022 Premium Concrete Services Inc (Principal) ' (Seal) (Wi ess) (Title) `Ns,,,, Old Republic Insurance Company (Surety) _S (Witness) (Title) nifer L. Kasznia, ttorney-in-Fact CAUTION: You should sign an original AIA Contract Document, on w h this text appears in RED. An original assures that changes will not be obscured. AIA Document A31(F`e — 2010. Copyright ©1983, 1970 and 2010 by The American Institute of Architects. All rights reserved. WARNING: This AIAo Init. Document Is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA® Document, or any portion of it, may result In severe civil and criminal penalties, and will he prosecuted to the maximum extent possible under the law. f Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architectslegal counsel, copyright@aia.org. 061110 * OLD REPUBLIC INSURANCE COMPANY POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That OLD REPUBLIC INSURANCE COMPANY, a Pennsylvania stock insurance corporation, does make, constitute and appoint: NICOLE L BICKNELL, MEGAN E RIESENBERG, MARK EDWARD WOBBE, BARBARA E PEARSON, JENNIFER L KASZNIA, SANDRA L JUNK, WILLIAM J CERNEY, III, WESLEY MANTOOTH, THERESA BURNS, JORDAN SCHEMER, LISA M THOMAS, FAITH HUNT, PAMELA S. HIGGINBOTHAM of SOUTH BEND, IN its true and lawful Attorney(s)-in-Fact, with full power and authority for and on behalf of the Company as surety, to execute and deliver and affix the seal of the Company thereto (if a seal is required), bonds, undertakings, recognizances or other written obligations in the nature thereof, (other than self-insurance workers compensation bonds guaranteeing payment of benefits, or black lung bonds), as follows: ALL WRITTEN INSTRUMENTS IN AN AMOUNT NOT TO EXCEED TWENTY MILLION ($20,000,000) FOR ANY SINGLE OBLIGATION and to bind OLD REPUBLIC INSURANCE COMPANY thereby, and all of the acts of said Attorneys -in -Fact, pursuant to these presents, are ratified and confirmed. This appointment is made under and by authority of the board of directors at a meeting held on December 10, 2019. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the board of directors of the OLD REPUBLIC INSURANCE COMPANY on December 10, 2019. RESOLVED FURTHER, that the chairman, president or any vice president of the Company's surety division, in conjunction with the secretary or any assistant secretary of the Company, be and hereby are authorized and directed to execute and deliver, to such persons as such officers of the Company may deem appropriate, Powers of Attorney in the form presented to and attached to the minutes of this meeting, authorizing such persons to execute and deliver and affix the seal of the Company to bonds, undertakings, recognizances, and suretyship obligations of all kinds, other than bail bonds, bank depository bonds, mortgage deficiency bonds, mortgage guaranty bonds, guarantees of installment paper and not guaranty bonds. The said officers may revoke any Power of Attorney previously granted to any such person. RESOLVED FURTHER that any bond, undertaking, recognizance, or suretyship obligation shall be valid and binding upon the Company (i) when signed by chairmen, president or anyvice president of the Company's surety division and attested and sealed (if a seal be required) by any secretary or assistant secretary; or (ii) when signed by a duly authorized Attorney -in -Fact and sealed with the seal of the Company (if a seal be required). RESOLVED FURTHER, that the signature of any officer designated above, and the seal of the Company, may be affixed by facsimile to any Power of Attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually affixed. IN WITNESS WHEREOF, OLD REPUBLIC INSURANCE COMPANY has caused these presents to be signed by its proper officer, and its corporate seal to be affixed this 25th day of August 2021 OLD REPUBLIS 11I�CE COMPANY 1 "y SEAL �= Assistant e ------,y 3� ��+\� thy+` Vice President STATE OF WISCONSIN, COUNTY OF WAUKESHA- SS°�,'_ On this 25th day of August 2021 , personally came before me, Alan PaVIIC and Karen J, Haffner , to me known to be the individuals and officers of the OLD REPUBLIC INSURANCE COMPANY who executed the above instrument, and they each acknowledged the execution of the same, and being by me duly sworn, did severally depose and say: that they are the said officers of the corporation aforesaid, and that the seal affixed to the above instrument is the seal of the corporation, and that said corporate seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority of the board of directors of said organization. ..;aU66Np Nalary Public September 28 2022 My Commission Expires: CERTIFICATE (Expiration of notary's commission does not invalidate this instrument) I, the undersigned, assistant secretary of the OLD REPUBLIC INSURANCE COMPANY, a Pennsylvania corporation, CERTIFY that the foregoing and attached Power of Attorney remains in full force and has not been revoked; and furthermore, that the Resolutions of the board of directors set forth in the Power of Attorney, are now in force. r �J`�NSu"`y"me 7th July 2022 Signed and sealed at the City of Brookfield, WI this day of SEAL_ 45-5314 ORSC 11008 (6-93) „°^„ As t.ot S., u y GIBSON INSURANCE AGENCY, INC, PART II (For projects of $100,000 or more —I C 36-1-12-4) These statements to be submitted under oath by each bidder with and as part of his/her/its bid. Attach additional pages for each section as needed. SECTION I EXPERIENCE QUESTIONNAIRE 1. Attach information regarding projects your organization has completed for the period of one (1) year prior to the date of the current bid. 2. Attach a listing of public works projects currently in process of construction by your organization. 3. Attach information regarding any failure to complete any work awarded to you and the location thereof. 4. Attach references from private firms for which you have performed work. SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE 1. Attach an explanation of your plan or layout for performing proposed work. (Examples could include a narrative of when you could begin work, complete the project, number of workers, etc. and any other information which you believe would enable the City of South Bend to consider your bid.) 2. Attach a listing of the names and addresses of all subcontractors (i.e. persons or firms outside your own firm who have performed part of the work) that you have used on public works projects during the past five (5) years along with a brief description of the work done by each subcontractor. 3. If you intend to sublet any portion of the work, attach the name and address of each subcontractor, equipment to be used by the subcontractor, and whether you will require a bond. However, if you are unable to currently provide a listing, please understand a listing must be provided prior to contract approval. Until the completion of the proposed project, you are under a continuing obligation to immediately notify the City of South Bend in the event that you subsequently determine that you will use a subcontractor on the proposed project. 4. Attach a listing of equipment you have available to use for the proposed project. 5. Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing your proposal? If not, attach an explanation for the rationale used which would corroborate the prices listed. SECTION III CONTRACTOR'S FINANCIAL STATEMENT Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial statement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to the City of South Bend awarding the contract must be specific enough in detail so that said City of South Bend can make a proper determination of the bidder's capability for completing the project if awarded. Version 09/29/2021 Contractor's Bid for Public Works - 3 Premium Concrete Services, Inc. 712 Richmond Street Elkhart, IN 46516 (574)264-0196 SECTION I EXPERIENCE QUESTIONAIRE 1) PUBLIC WORKS PROJECTS COMPLETED IN PAST YEAR: CONTRACT AMOUNT COMPLETION DATE OWNER $ 657,021.80 CONCRETE ROADWAY 10/18/21 CITY OF GOSHEN $ 250,000.00 CURB & SIDEWALK 12/31/21 CITY OF MISHAWAKA $ 163,377.40 CURB & SIDEWALK 12/31/21 CITY OF ELKHART 2) PUBLIC WORKS PROJECTS IN PROGRESS: CONTRACT AMOUNT COMPLETIO N DATE OWNER $ 187,300.00 CURB RAMP 10/2022 CITY OF ELKHART +/- $200,000.00 CURB & SIDEWALK 10/2022 CITY OF MISHAWAKA +/- $1001000.00 STREET MATERIALS 10/2022 CITY OF ELKHART 3) HAVE NEVER FAILED TO COMPLETE ANY WORK THAT WAS AWARDED TO US. 4) REFERENCES: a. NISOURCE —MR. LUKE BRADLEY -1039 PENNSYLVANIA AVE SOUTH BEND, IN 46601 b. LOZIER MANUFACTURING—MR. KEN MURR-402 N MAIN MIDDLEBURY, IN 46540 Premium Concrete Services, Inc. 712 Richmond Street Elkhart, IN 46516 (574) 264-0196 SECTION II PLAN AND EQUIPMENT QUESTIONAIRE 1) Project No. 122-0012022 Curb & Sidewalk Construction - Schedule: After given the notice to proceed Premium Concrete Services, Inc. will create a letter to hand out to residents with details of upcoming work. PCS will then contact Indiana 811 to locate all utility lines within construction limits. Layout and staking of site will be next. Then removals, excavation, grading & subgrade will begin for concrete work. After excavation and grading phases are complete, concrete work will commence. Crews of 4-6 workers will install. Finally top soil and seeding, followed by tree planting at the appropriate time. Project with be completed on schedule. 2) a) State Barricading Inc.- 24963 US 20 West South Bend, IN 46628 —Traffic Maintenance & Signs b) Acorn Landscaping— 3680 W Sample St South Bend, IN 46619—Top Soil and Sodding. c) Kachur Tree Service, LLC -316 Fulkerson Rd Niles, MI 49210 -Tree Removal. d) Hawk Enterprises —1850 East North St Crown Point, IN 46307 - Electric e) KC Tree, Inc — 8913 East US Hwy 20 New Carlisle, IN 46552 —Tree Removal f) A-1 Striping Service Inc. — 56825 Spirea Rd. New Carlisle, IN 46552 — Painting g) Kennedy Expressline Inc. —South Bend, IN 46628 - Hauling h) Traffic Control Specialists —1810 W Pacific Ave Knox, IN 46534 —Traffic Maintenance & Signs Premium Concrete Services, Inc. Does not require bonding for its subcontractors 3) Will supply list of subcontractors soon after award of project. 4) Equipment use for project: Skid Steer, Mini Excavator, Excavator, Compactor, Roller, Walk -behind Saw, Cut-off Saw, Friction Screed, Dump Truck. Current plan is to used owned equipment, however depending on workload some rental equipment may be necessary. 5) Yes, Premium Concrete Services, Inc. has quotes for all materials in proposal. Premium Concrete Services, Inc. Elkhart, Indiana Annual Report December 31, 2020 Contents Report of Independent Accountant on Financial Statement ........................ 1 Financial Statements Statement of Income and Retained Earnings ................................ 2 BalanceSheet................................................................................ 3 Statement of Cash Flows............................................................... 4 Notes to the Financial Statements ................................................. 5 - 8 Supplemental Schedules ...................... 9 - 10 When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit. CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON- DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS (Must be completed for all quotes and bids. Please type or print) STATE OF,DIA�S ) SS: ELKAPUT PU' COUNTY ) The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury that: 1. Contractor has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and 2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency; and 3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investment activities in Iran. a. For purposes of this Certification, "Iran" means the government of Iran and any agency or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from time -to -time. b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor is engaged in investment activities in Iran if either: i. Contractor, its successor or its affiliate, provides goods or services of twenty million dollars ($20,000,000) or more in value in the energy sector of Iran; or ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty million dollars ($20,000,000) or more in credit to another person for forty-five (45) days or more, if that person will (i) use the credit to provides goods and services in the energy sector in Iran; and (ii) at the time the financial institution extends credit, is a person identified on list published by the Indiana Department of Administration. 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 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 subcontractor 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, orjoint 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 lure, 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 perforin the work. In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials, or ally combination of the foregoing including, but not limited to, public works contracts awarded under public bidding laws or other contacts 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 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. *r* 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 a4k day oQQ , 20al �.Efnlumrs�►yc.R� i ESV ic��S, 7►�c . Contractor/Bidder (Firm) Signature offfContractor/Bidder or Its Agent fWalo gs We ,mclr . Printed Name and Title Subscribed and sworn to before me this 'a�1 day of JUuw , 20 My Comtnission Expires ba a C)P-%-LL Noilky Public County of Residence CLMAP—T JANEE M TOWNER NOTARY PUBLIC SEAL ELKHART COUNTY, STATE OF INDIANA MY COMMISSION EXPIRES FEBRUARY 12, 2026 COMMISSION NO. 710399 Version 09/29/2021 Contractor's Bid for Public Works - 6 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: 122-001 Project Name: 2022 Curb and Sidewalk Construction - Round 1 Bidder: (PRErcttti,� ? C&OC AM Total Bid Amount: $ -39 3 2 pages Division 1 - MBE Goal: 3.0% Division 1 Bid Amount: No W-4-0 Name &Address of MBE Primary Contact Person (Name/Telephone) Scope of Work to be Performed (Attach scope/schedule if you need additional space) p,�pUTH\\ CITY OF SOUTH BEND-?, MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN`_.; I i FORM MBE -1.0 j 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: 122-001 Project Name: 2022 Curb and Sidewalk Construction - Round 1 Bidder: (PRErcttti,� ? C&OC AM Total Bid Amount: $ -39 3 2 pages Division 1 - MBE Goal: 3.0% Division 1 Bid Amount: No W-4-0 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 (Name/Telephone) (Attach scope/schedule if you need additional space) Component Bid/Proposal Division 2 - MBE Goal: 3.0% Division 2 Bid Amount: Nc) 2 Name &Address of MBE Primary Contact Person Scope of Work to be Performed Dollar Amount of MBE Percentage of Total (Name/Telephone) (Attach scope/schedule if you need additional space) Component Bid/Proposal Version 09/29/2021 Contractor's Bid for Public Works -12 0 CITY OF SOUTH BEND ' MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE -1.0 ` 1; MBE UTILIZATION PLAN — as Division 3 — MBE Goal: 3.0% Division 3 Bid Amount: f r, -S/ Primary Contact Person Name &Address of MBE Scope of Work to be Performed Dollar Amount of MBE Percentage of Total (Name/Telephone) (Attach scope/schedule'rf you need additional space) Component Bid/Proposal KEWWc4y Ey&E,95i-rVE M#A446 NA¢/HE4 ft_d„ N� l�Q�krNG l� 3 z�� y3aYAs:IARA DR Sourµ/3F�rO(57`157/0-8861 (� ob q � 6/6 q �/(�Gsz6 ny �7G-8881 Z-�G (T4a4kx+1GI Division 4 — MBE Goal: 2.0% Division 4 Bid Amount: /,�O/ 6B.S Name &Address of MBE Primary Contact Person Scope of Work to be Performed Dollar Amount of MBE Percentage of Total (Name/Telephone) (Attach scope/schedule if you need additional space) Component Bid/Proposal KCA.wcoY xpR(SfCSNE AsMgRo o� /r/w(u�9 A;0&r4_44a ) Fes} (� ob q � 6/6 q �/(�Gsz6 ny �7G-8881 Z-�G (T4a4kx+1GI Division 5 — MBE Goal: 2.5% Division 5 Bid Amount: /,//" %df3 Name &Address of MBE Primary Contact Person Scope of Work to be Performed Dollar Amount of MBE Percentage of Total (Name/Telephone) (Attach scope/schedule if you need additional space) Component Bid/Proposal Kr,u.uEOV Eer ex &0 ZrdE YU4 145440" " /,1AAa,5 NO, Th'P—t i4*u�W6 lrRu�� � 3?550 = q � 6/6 E10,0., =,v ' k.z� 5?4)-K-9BSI Submitted by: 91>6 &Ck-F—i- Print Name 2&:w= 7/<122 S&at re Date Version 09/29/2021 Contractor's Bid for Public Works - 13 CITY OF SOUTH BEND >` MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN r -,- 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: Bidder: 122-001 Project Name: 2022 Curb and Sidewalk Construction — Round 1 P9F_ 1Su.ry (0AC4eTE 5ER✓lc6gTotal Bid Amount: 39 34 IoBS� Division 1 — WBE Goal: 5.0% Division 1 Bid Amount: PO 8,TD 2 pages Name &Address of WBE Primary Contact Person Scope of Work to be Performed Dollar Amount of WBE Percentage of Total (Name/Telephone) (Attach scope/schedule if you need additional space)Component Bid/Proposal Division 2 — WBE Goal: 5.0% Division 2 Bid Amount: No &_zQ Name &Address of WBE Primary Contact Person (Name(relephone) Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of WBE Component Percentage of Total Bid/Proposal Version 09/29/2021 Contractor's Bid for Public Works - 14 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM WBE-1.0 WBE UTILIZATION PLAN U/ -02- Division 2Division 3 — Kf3E Goal: 5.5% Division 3 Bid Amount: /CV Name 8 Address of WBE Primary Contact Person Scope of Work to be Performed Dollar Amount of WBE Percentage of Total ��v 1�C.nI�'Li (Pq ! -a079 (Name/Telephone) (Attach scope/schedule if you need additional space) Component Bid/Proposal yr'aTG gr�,eRscaosN` 7+1�},RY MS —1,X4f1-L C- ae `�Faa� — % 2v4TµLj q 7-.�0 00 Division 4 — WBE Goal: 4.5% Division 4 Bid Amount: 130 % ¢S Name &Address of WBE Primary Contact Person Scope of Work to be Performed Dollar Amount of WBE Percentage of Total ��v 1�C.nI�'Li (Pq ! -a079 (Name/Telephone) (Attach scope/schedule if you need additional space) Component Bid/Proposal TG R SGRDSn16 ,403 u5 .Z? /1//{a j/ (sib —1,X4f1-L C- ae `�Faa� — 2,7& q 7-.�0 Ll�g oO Division 5 )OBE Goal: 4.5% Division 5 Bid Amount: ly7' / Name 8 Address of WBE Primary Contact Person Scope of Work to be Performed (Name/Telephone) (Attach scope/schedule if you need additional space) Dollar Amount of WBE Component Percentage of Total Bid/Proposal �¢YE OrAJG ��v 1�C.nI�'Li (Pq ! -a079 -3 Submitted by: R66 /3fc-4,Ek 2 /�ii 7//,2/-22- Print //,2/-2z Print Name Signature Date Version 09/29/2021 Contractor's Bid for Public Works - 15 CITY OF SOUTH BEND j MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE -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 MBE participation. Project Number: 122-001 Date: 2 %?1�2 Z_ Project Name: 2022 Curb and Sidewalk Construction — Round 1 Bidder: ogp_pzr4r�J t bw4<ETc- i1✓ra4 Contact Person: Wo 3 SELKl=!L Telephone: Address: lZrC6"onl0 ST ` � City: E(J4, 9 444— State: SN Zip: t l Email: Gt'lSAf2e ®RE�irK �r CdA�REr� dyG� , (� To determine whether a bidder has demonstrated good faith efforts to reach the MBE 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 - 16 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.gov/idoa/. 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 ,1-7 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 MWBEs, including, where appropriate, breaking out contract work items into r 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 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. I 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 - 16 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 - 17 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 - 17 CITY OF SOUTH BEND um MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLANFORM 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: 122-001 Date: Project Name: 2022 Curb and Sidewalk Construction - Round 1 Bidder: Contact Person: 6AL Telephone: Address: / 1.2- R_rCb/ ,OA% 0 s?::P6 -�--" City: l ky'l- C7— State: : iv Zip: Email: gA&KEiiG_ PACOI u w? 60-/6k4Crb_-0A/4.—N4r_. G0/+7 To determine whether a bidder has demonstrated 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 - 18 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: hftp://www.in.gov/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:/Mww.in.gov/ldoa). 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 Yy\ 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 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 nn with adequate information about the plans, specifications and other requirements of the nY subcontract. I affirm that I have made good faith efforts to assist interested WBEs in obtaining bonding, v 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 - 18 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 - 19 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. �n �U7 1 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 - 19 CITY OF SOUTH BEND I j MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE -2.1_ i MBE CONTACTED This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring Good Faith Efforts to contact MBEs. It is the bidder's sole responsibility to verify whether any listed minority-owned business meets the MBE qualifications. Attach additional pages if necessary. PAGE OF Project Number: 122-001 MBE Participation Goal Project Name: 2022 Curb and Sidewalk Construction - Round 1 Bidder: 0 560J=0z MBE Firm kE'NAJEOr E X PAESS 4rAJE Owner or Contact at MBE Firm M,¢Rc4(5 A)ORTHEA)u Telephone: Fax: Fax: TYPE OF WORK SOLICITED FOR THIS PROJECT: #RuG=NG /-rguGKs uG Varies 7//2 /a Z_ Email: kE+ani Fny EritEsSlS�tF� yAdA0,4" RESULTS OF CONTACT WITH THE MBE FIRM: OX LL- wrri rZE =tF 4&),4 0�O MBE Firm Owner or Contact at MBE Firm Telephone: Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBE FIRM: Version 09/29/2021 Contractor's Bid for Public Works - 20 CITY OF SOUTH BEND t MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN uk� % FORM MBE -2.1 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_I_L_OF L Project Number: 122-001 WBE Participation Goal Varies Project Name: 2022 Curb and Sidewalk Construction - Round 1 Bidder: PIfEMZu C&t)eXErE SEXOXrC5 By: �,, SE.t12oR EsrsnATe.Q 7 /2 ��'L WBE Firm 5iRTC- 640(rC.40X-A)G Owner or Contact at WBE Firm 07,41ti /rJScIFM 3 Telephone: -2y a$7 ap%g Fax: Email: .pq�RugAe yL�yL, C4241TYPE OF WORK SOLICITED FOR THIS PROJECT: T AFF�� Gots r'aoc. RESULTS OF CONTACT WITH THE WBE FIRM: L�IGr. U7-r/,rgn& 17r- WBE 7FWBE Firm LG(55£.2 5 GREEN Owner or Contact at WBE Firm CpRo(,ya) SL K3'3E Telephone: (�%y� 7.2i2 -� 943 Fax: EmailjjFp 51uS1iERs , LOe+t �,53� uEtS r "I TYPE OF WORK SOLICITED FOR THIS PROJECT: i RESULTS OF CONTACT WITH THE WBE FIRM: Nb RE�� Version 09/29/2021 Contractor's Bid for Public Works - 21 o� ni_acry ,. 4 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN .! FORM MBE -2.1 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_2_—OF 2— Project Project Number: 122.001 WBE Participation Goal Varies Project Name: 2022 Curb and Sidewalk Construction – Round 1 Bidder: La E57s^4ro2 ;? --- WBE Firm tel- /Z 7AuckZ.A)6 Owner or Contact at WBE Firm ()E49,4 GD 10EV-49:_ Telephone: Fax: Fax: Email• RFSaMf;NG2,gx�!>`�%�OL,(D�7 TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE WBE FIRM: NO REPty /,fru.- urrL.zzE xF RaTE9 -ff kE Co�tPErs rrvE fFA10 WE 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 - 21 CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK RESPONSIBLE BIDDER CHECKLIST Project Name 2022 Curb and Sidewalk Construction— Round 1 Project No. 122-001 For Bids Due July 12'", 2022 Contractor Name: rJREm_ru� C'")a c rz �j E C ✓ZG�j 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. If you are a pre -qualified bidder, complete Section I only. If you are not a pre -qualified bidder, complete Section II only. Section II acts as an application for pre -qualification. Submission of Section II will allow the bidder to be considered for pre -qualification for bids with the City of South Bend Department of Public Works. Pre- qualified bidders will then be exempt from a portion of the submission requirements outlined in Section 6- 63 of The Responsible Bidding Ordinance No. 10594-18 (hereinafter, "Responsible Bidding Ordinance") for a period of twelve (12) months. Thereafter, contractors who are pre -qualified must submit a complete application for continuation of "pre- qualified" standing, on a form provided by the City ("Responsible Bidder Checklist (1) Pre -Qualified Bidders") by December 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 02/23/2022 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 Subcontractors)") to the City by a bidder shall not create any rights in the Disclosed Subcontractor(s). Thus, a bidder may substitute another subcontractor for a Disclosed Subcontractor by giving the City, upon request, written notice of the name, address, licensing status, and type of work of the substitute subcontractor. 5. The successful bidder and all subcontractors on a public works project are required to submit certified payroll utilizing the federal form known as WH -347 or a similar form on a bi-weekly basis, submitted within 10 days after the end of each bi-weekly payroll period. Certified payrolls shall identify the job title and craft for each employee. Certified payrolls shall be submitted electronically. Please Note: Submissions deemed inadequate, incomplete, or untimely by the City may result in the automatic disqualification of the bid. The City, after review of complete and timely submissions, shall, in its sole discretion, after taking into account all information in the submission requirements, determine whether a bidder is responsive and responsible, and provide a Pre -Qualification Verification Letter. The City specifically reserves the right to utilize all information provided in the contractor's submission and any information obtained by the City through its own independent verification of the information provided by the contractor. Version 02/23/2022 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 02/23/2022 General Conditions - 12 If. 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. By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided, and may also conduct random inquiries of my current and prior customers. The City reserved the right to utilize all information provided in this submission and all information obtained in inquiries or requests to determine if a bidder is responsive and responsible. Additionally, I acknowledge that all information provided to the City shall be regarded as public records. (iii) By checking this box, I hereby acknowledge that copies of all Applicable apprenticeship certificates or standards for training programs applicable to the work performed on the project may be requested at any time and shall be furnished upon request. (iv) _ By checking this box, I hereby acknowledge and ensure that I and all sub- contractors, from whom I have accepted a bid and/or intend to hire to perform work on the public work project, are properly licensed. Furthermore, I acknowledge my understanding that it is my responsibility to ensure that all sub -contractors have the necessary licenses to undertake the work called for in this bid. If a sub- contractor loses their license at any point, it is the responsibility of that sub- contractor to notify the City. (b) Attachments: (i) A 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). List identifying all former business names. 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 02/23/2022 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) —V 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: (Sign Here) /703 �3E�� rz (Print Name Here) (Name of Company) 7/.Z ��`"roa) b 5� (Address of Company) Elg N A2T— (city) T�AD (State) (Telephone Number) Version 02/23/2022 General Conditions - 14 State of Indiana Office of the Secretary of State CERTIFICATE OF EXISTENCE To Whom These Presents Come, Greeting: I, HOLLI SULLIVAN, Secretary of State of Indiana, do hereby certify that I am, by virtue of the laws of the State of Indiana, the custodian of the corporate records and the proper official to execute this certificate. I further certify that records of this office disclose that PREMIUM" CONCRETE SERVICES, INC. duly filed the requisite documents to commence business activities under the laws of the State of Indiana on November 24, 2004, and was in existence or authorized to transact business in the State of Indiana on March 01, 2022. I further certify this Domestic For -Profit Corporation has filed its most recent report required by Indiana law with the Secretary of State, or Is not ye(required to file such report, and that no notice of withdrawal, dissolution, or expiration has been filed or taken place. All fees, taxes, interest, and penalties owed to Indiana by the.. domestic or foreign entity and Collected by the Secretary of State have been paid. In Witness Whereof, I have caused to be affixed my signature and the seal of the State of Indiana, at the City of Indianapolis; March 01, 2022 HOLLI SULLIVAN SECRETARY OF STATE 2004120100105/ 20222461045 All certificates should be validated here: https://bsd.sos,in,gov/ValidateCertificate Expires on March 31, 2022. Premium Concrete Services, Inc 712 Richmond Street Elkhart, IN 46516 574-264-0196 fax 574-266-5392 03/02/2022 To Whom it may concern, Premium Concrete Services, Inc, currently employs 27 people, 5 of which are field supervisors, 6 concrete finishers, 11 laborers and 4 heavy equipment operators. We are signatory to the local Cement Masons, Laborers and Operator's unions through which extra employees can be pulled from when needed. Max Yeakey VP Premium Concrete Services, Inc 712 Richmond Street Elkhart, IN 46516 574-264-0196 fax 574-266-5392 03/02/2022 To Whom it may concern, Premium Concrete Services, Inc. has all employees properly classified under all applicable state and federal laws and local ordinances, as well as any independent contractors that would potentially be called upon to assist in completing a job. Max Yeakey VP March 3, 2022 'Po Whom it May Concern: 'Phis is a letter to inform you that Premium Concrete Services, Inc„ is a contractor member of the Building & Construction Resourcc Center Inc, (BCRC) drug testing program. They are a contributing client and meet all (lie industry standards set by the Business Roundtable of Northwest Indiana, the Substance Abuse & Mental Health Services Association, and the Drug & Alcohol Testing Industry Association, and the Department of Transportation. Please be advised that Premium Concrete Services, Inc. located at 712 Richmond St, Elkhart, IN 46516 is a participating employer in good standing with BCRC. All of Premium Concrete Services, Inc.'s Employees are subject to the terms of the BCRC Drug Testing Policy, which meds or exceeds the requirements of IC 4-13-18-5 or IC 4-13-18-6. Please direct any questions regarding this correspondence to me. Sincerely, Laru&(w2oadv Laticia Roach Executive Director 13CRC Administrator, Inc, 219-764-1488 IItomolin(,i Ilse Safely and Well -Being of I rnployees in Itie Workplace Buihling & Consbvelion Resource Cosh% Ina, r, PI(one: (219) 764-9500 - Fax: (219) 764-9.505 6050 Soullryort Road, Suile 13 n Portage, Irulinun 4068 euenrn.hcrcneLcau _�" Old Republic Surety Company PO Box 1635 Milwaukee, WI 53201-1635 CONTINUATION CERTIFICATE W1501 11 104719 Building Contractor 5,000.00 09/12.12021 09/12/2022 ^PRINCIPAL Premium Concrete Services, Inc 712 RICHMOND STREET ELKHART,IN 46516 ORT IYGER, South Bend -St Joseph County 125 S Lafayette Ste 100 South Bend, IN 46601 ORIGINAL FOR BOND RENEWAL THIS BOND CONTINUES IN FORCE TOTER ABOVE EXPIRATION DATE CONDITIONED AND PROVIDED THAT THE LOSSES OR RECOVERIES ON 1'1' AND ANY AND ALL ENDORSEMENTS SHALL NEVER EXCEED THE PENALTY SET FORTH IN THE BOND AND WHETHER THE LOSSES OR RECOVERIES ARE WITHIN THE FIRST ANDIOR SUBSEQUENT OR WITHIN ANY EXTENSION OR RENEWAL PERIOD, PRESENT, PAST OR FUTURE. ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. SIGNED AND DATED THIS 0465314 GIBSON INSURANCE AGENCY, INC. 202 SOUTH MICHIGAN ST STE 1400 SOUTH BEND, IN 46601 574-245-3500 ORS022054(8N4) DAY OF June 2021 Old Republic Surety Company SURETYpV�.y $°�yoSEAT,y6' 4 ATTORNGY.M.FACS OLD REPUBLIC sun Ty COMPANY POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS; That OLD REPUBLIC SURETY COMPANY, a Wisconsin stock Insurance corporation, does make, constitute and appoint: Fiise Faust of Brooldfleld, WI its true and lawful Aftorney(s)-in-Fact, with full power and authority, not exceeding $10,000,000, for and on behalf of the company as surety, to execute and deliver and affix the seal of the company thereto (If a seal Is required), bonds, undertakings, recognizances or other written obligations in the nature thereof, (other than hail bonds, bank depository bonds, mortgage deficiency bonds, mortgage guaranty bonds, guarantees of Installment paper and mote guaranty bonds, self-insurance workers compensation bonds guaranteeing payment of benefits, asbestos abatement contract bonds, waste management bonds, hazardous waste remediation bonds or black lung bonds), as follows; Effective Date: 9/12/2021 12:00:00 AM Bond Number: W150104719 Bond Amount: Five Thousand Dollars $5,000.00 Principal Name: Premium Concrete Services, Inc Obligee Name: South Bend -St Joseph County of South Bend, IN and to bind OLD REPUBLIC SURETY COMPANY thereby, and all of the acts of said Attorneys -in -Fact, pursuant to these presents, are ratified and confirmed, rhis appointment Is made under and by authority of the board of directors at a special meeting held on February 18, 1982, This Power of Attorney is signed and sealed by facsimile under and by the authority or the following resolutions adopted by the board of directors of the OLD REPUBLIC SURETY COMPANY on February 18,1982. RESOLVED that the president, any vice president or assistant vice president, in conjunction with the secretary or any assistant secretary, may appoint attorneys -in -fact or agents with authority as dented or limited In the instrument evidencing the appointment in each case, for and on behalf of the company to execute and deliver and affix the seal of the company to bonds, undertakings, recognizances, and suretyship obligations of all kinds; and said officers may remove any such attorney-m4act or agent and revoke any Power of Attorney previously granted to such person. RESOLVED FURTHER that any bond, undertaking, recognizance, or suretyship obligation shall be valid and binding upon the Company (i) when signed by the president, any vice president or assistant vice president. and attested and sealed (if a seat be required) by any secretary or assistant secretary; or (li) when signed by the president, any vice president or assistant vice president, secretary or assistant secretary, and countersigned and sealed (if a seal be required) by a duly authorized attorney-in-fact or agent; or (iii) when duly executed and sealed (if a seat be required) by one or more attorneys -In -fact or agents pursuant to and within the limits of the authority evidenced by the Power of Attorney Issued by the company to such person or persons. RESOLVED FURTHER that the signature of any authorized officer and the seal of the company may be affixed by facsimile to any Power of Attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the company; and such signature and seat when so used shall have the same force and effect as though manually affixed. IN WITNESS WHEREOF, OLD REPUBLIC SURETY COMPANY has caused these presents to be signed by Its proper officer, and its corporate seal to be affixed this 9th day of June 2021 "'I",c'suq,r,,, OLD REPUBLIC SUR TY COMPANY r =, D�SBAL l Assistant eecralar °eon ,m i' \so' President , mnn STATE OF WISCONSIN, COUNTY OF WAUKESHA- SS On (his 211 day of June 2021 , personally came before me, Alan Pavlic and Daren J. Haffner , to me known to be the individuals and officers of the OLD REPUBLIC SURETY COMPANY who executed the above instrument, and (hey each acknowledged the execution of the same, and being by me duly sworn, did severally depose and say: that they are the said officers of the corporation aforesaid, and that the seal affixed to the above Instrument Is the seal of the corporation, and that said corporate seal and their signatures as such officers were duly affixed and subscribed to the said Instrument by the authority of the board of directors of said corporation. ro ab'....a^it -.�^i:' , �ityygAtm. fl•1�j,0/7;5{YvL" ,,;�"� Notary Public My Commission Expires: 0912812022 CERTIFICATE (Expirotion of notary's commission does not invalidate this Instrument) I, the undersigned, mn istant secretary of the OLD REPUBLIC SURETY COMPANY, a Wisconsin corporation, CERTIFY that the foregoing and attached Power. of Attorney remains in full force and has not been revoked; and furthermore, that the Resolutions of the board of directors set forth in the Power of Attorney, are now in force. su,u......,,, 0455314 .�¢v....... .r+<' Signed and sealed at the City of Brookfield, WI this 9t1 dayofJuno 2021 , O IVD1 Y� ORSO 22262(8 06) �"r°"^"jmm•D";L \" Assislant secretary GIBSON INSURANCE AGENCY, INC. INDIANA LABORERY TRAINING TRUST FUND David A. Frye Secretary -Treasurer Jerry J. Bolk Chris L. Guerrero Ricky Henson, .h,. Ramon Mendoza, h% Danay L. Stalls P.O. Box 758 - Bedford, Indiana 47421 (812)279-9751 February 23, 2021 To Whom It May Concern: Sean Coakley, Direolor John P. Brown Chairman Kelly Abel Michael Ferrara Stan Meyer Nick Timmerman Jim Wiseman FAX: (812) 279.554.5 Toll Free (800) 742-4086 This letter is to confirm tbat "Premium Concrete Services, Ino." is a signatory contractor in good standing with the Indiana Laborers' Training Trust Frurd. The abovementioned company is a participant in the Joint Apprenticeship and Training Committee through this Union and has been an active participant in good standing for each of the past five plus consecutive years and is currently eligible to use our apprentices on a project. Further, our organization's program is approved by the U.S. Veterans Administration to participate in the GI educational benefits program. A copy of our approval letters are attached along with the collective bargaining agreement stating the ratios of Journey workers to Apprentices; which is one (1) Apprentice for every four (4) Journey workers and thereafter may not employ more that (1) Apprentice for every (3) Journey workers. Sincerely, Sean Coakley, Director SC. -jt www. indianalaborerstraining,org l ft.,i. Taft-fibcate of lNDTANA LABORER'S TRAINING TRUST FUND BEDFQRD, TNDTANA- for the trade classificat±on of CONSTRUCTION CRAIT LABORER Re# J' siere of as parl o reni '11-4e Xabonaif 74ppzcesAip J:�-oyram in accorofance wife h6e &7sic sfankrofs of appreniicesAip e.YIC7�.&16ecf�y the c3ecrelary p December 14, 1995 Dar IN040-0528 STATE OF Ii Pft DEPARTMENT OF VETERANS AFFAIRS STATE APPROVING AGENCY 402 WEST WASHINGTON STREET ROOM W-469 INDIANAPOLIS, INDIANA 46204-2736 Jeremy Brewer Apprenticeship Coordinator Indiana Labpaers Training I;ust Fund-Apprenticoship 439 Patton Hill Rd. Bedford, IN 47421 Dear Jeremy Brewer, Eric Holcomb, Governor Jarnes M. Brown, Director January 9, 2019 This will acl(nowledge receipt of your revised Work Processes for the Construction Craft Laborer program offered at Hoosier Energy, located in Bedford, Indiana. The State Approving Agency has reviewed the document as listed below: 'MWING PROGRAM LRNGTH AOT CODE Construction Craft Laborer 4,000-7800 hours 47-2061.00 FACILITY CODE: 30004914 To the best of my knowledge Indiana Laborers Training Trust Fund -Apprenticeship does not utilize erroneous or misleading advertisement, either by actual statement, omission, or iirtimation. It is understood by Indiana Laborers Training Trust Fund -Apprenticeship that they will maintain a complete record' of all advertising utilized by or on behalf of the company in regards to their training programs during the preceding 12 months. The company's advertising will be available for review by any and all futi re supervisory visits by the SAA, or the U.S. Department of Veteran Affairs. This approval is made pursuant to and under tho provisions of Title 38, U. S. Code 3687, with an effective date of January S, 2019. If you have any questions, please contact me at 317-232-3916. Sincerely, r Taniqua Griffin Program Director State Approving Agency Cc:VAROIFLR Phone(317)•234-6062 Toll Free(800)-400-4520 Fax(317).234.8744 STATE OF INDIANA DEPARTMENT OF VETERANS AFFAIRS STATE APPROVING AGENCY 402 WEST WASHINGTON STREET ROOM W-409 INDIANAPOLIS, INDIANA 46204-2738 Jeremy Brewer Apprenticeship Coordinator Indiana Laborers Training Trust Fund -Apprenticeship 439 Patton hill Rd. Bedford, IN 47421 Dear Jeremy Brewer, Eric Holcomb,: Governor James M. Brown, Director January 9, 2019 The Indiana State Approving Agency conducted a supervisory visit on 01/8/2019 at Indiana Laborers Training Trust Fund -Apprenticeship, The purpose of the visit was to provide training to the Certifying Officials and review enrollment certifications, record retention and reporting procedures. The organization demonstrated proper record maintenance and record maintenance and reporting procedures: During the visit, we discussed the importance of reporting hours on a monthly basis, good record keeping techniques, and how to report a leave of absence or completion via VA Form 22-1999b. We also updated the Certifyhrg Officials via VA Form 22-8794, work processes, and wage scale. if you need any assistance or have any questions regarding this technical visit please contact me directly at tgr'iffm@dva.in.gov or (317) 232-3916. Thank you for the courtesy extended during my visit. The education acrd training opportunities that your organization continues to provide veterans and their dependents are appreciated. Sincerely, Taniqua'Cniffin Program Director Phony (317)-234-6062 Toll Free (800)-400-4520 Fye (317)-234.8744 mp YOYtry�u4. STATE OF INDIANA DEPARTMENT OF VETERANS AFFAIRS STATE APPROVING AGENCY m m 402 WEST WASHINGTON STREET ROOM W469...�,, INDIANAPOLIS, INDIANA 46204-2738 Jeremy Brewer Appreuticesbip Coordinator Indiana Laborers Training Trust Fruid-Appreuticeship 439 Patton Hill Rd. Bedford, IN 47421 Dear Jeremy Brewer, Eric Holcomb, Governor James M, Brown, Director January 9, 2019 This will acknowledge receipt of your updated Wage Scale for the Construction Craft Laborer program offered by Indiana Laborers Training Trust Fund -Apprenticeship. The State Approving Agency has reviewed the document as listed below: Wage Scale: Construction Craft Laborer FACILITY CODE: 30004114 TO the best of ray 1m6wledge Tndiaua Laborers Training Trat Fun&Apprenticeship does,not utilizo earoneeus or misleadiirg advertiscmenfi either by actual staterxrent, onrissron, or ntunalion, It is ythrldstood by ludiana Laborers Training Trust Fund -Apprenticeship that they will maintain a complete record of all advertising utilized by or on behalf of the Indiana Laborers Training Trust Fund -Apprenticeship in regards to their training programs during the preceding 12 months. Indiana Laborers Training Trust Fund -Apprenticeship's advertising will be available for review by any and all future supervisory, visits by the SAA, or the U.S. Department of Veteran Affairs. PIease Review the entire packet for content and accuracy. Approval is granted pursuant to the provisions of Title 38, U.S. Code 3687, with an effective date of April 1, 2018. If you have any questions, please feel free to give me a call at 317-232-3 916 or email me at tgriffin@dva.in,gov. Thank you for what you do for our Veterans, and have a great day! Sincerely, C52116-11- Taniqua Griffm Program. Direct or State Approving Agency Cc: VARO/FLR rNor Nq 9 2099 Apprentice Status Deport By Indenture Date Apprentices Indentured Between 1/1/2020 And 12131/2020 Apprentice Program: IN2 Year Apprentice Status Apprentices Percentage Wma Gaga Printed: Tuesday, January 12, 2021 Active Duty 2 Adv. to Journeyman 8 1'iZ APPUCANT1 0.15 0/0 Not Registered 6 0188% Reinstate 2% 3 9;6 SOPended A 0.59%, Te urinated 8D ' 11,75 p% Voluntary withdraw 13 1.91 Total Indentured Gal Gaga Printed: Tuesday, January 12, 2021 Apprentice Status Report By Indenture Date Apprentices Indentured Between 1/1/2017 And 5/13/2020 Apprentice Program: IN2 Year Apprentice Status Apprentices Percentage 2�7Y ActiVe'' 156 22.67% KIM Active Duty 1 0.15 Adv. to Journeyman 47 6.83,% Deceased 4 0158% Graduated 45 6.54 %q Inactive 2 0129 % Jouineyrian i 1,14 Med. Susp, 4 0158% Reinstate ? ' 0.29'% Suspended 5 0.73% Terminatecl 396 57.56% Voluntary withdraw 25 3,63% Total Indentured 888 Active 283 " 32,3.6 °1a Active Duty 3 034 %° Advrio Journeyman 47 5,38 °Io Deceased 3 0,34% Graduated 5 0,57 Inactive l0 1,14 Journeyman 2 0,23 %u Med. Susp, 4 0.46% Reinstate 15 1,72% Suspended 8 0.92% Term(nated 462 52.8.6 Voluntary withdraw 32 3.66 Total Indentured 874 Printed: Wednesday, May 13, 2020 ---Page 1 of 1 Apprentice Status Report By Indenture Date AppYenttcoo Indentured Beiwoen 111/2017 And 0/13/2020 Apprenticln Program, IN2 Year Apprentice Status Apprentices Percentage 2019 2020 Actlye ;! 75 6;91 Med. Susp. 65.92°/0 Adv. Co Journeyman ii`el4*9 2t3 6.10 °Lo 2,86 Deceased 1.22 3 0,31'.%, Graduated 1 QAc % Inactive: journeyman 13 1,33% Med, Susp 2 0,2O °C° Reinstate 29 2.96% Suspended 4 %41;% Terminated 201 20.53% Voluntary withdraw tO 4.70 °lo Total indentured 979 Aetive> 75 91,4& Med. Susp. i 1;22 ii`el4*9 5 6.10 °Lo Terminated 1 1.22 Total Indentured $2 —mm—RaOe 2.0! 2. Printed: Wednesday, May 13, 2020 Plasterers' & Cement Masons' Apprenticeship Coordinator Local Union #692 To Whom it May Concern: Phone: (219) 707-7767 Ernaii: bl<ristoff@piciniocal692.org February 26, 2021 This letter is to certify that Premium Concrete Services Inc. is and has been a signatory contractor with OPCMIA Local 692 and has participated in the Plasterers & Cement Masons Apprenticeship Training Program for many years. Premium Concrete Services Innis a valued Contractor in good standing with Local 692 and the JATC. All our apprentices are registered with the United States Department of Labor. I may be reached at (219) 707-7767 if additional information is needed. Further, our organization's program is approved by the U.S, Veterans Administration to participate in the GI Education Benefit Program. Thank you, Brian Kristoff Apprentice Coordinator Plasterers & Cement Masons 9200 Louisiana Street • Merrillville, Indiana 46410 1NM1W.PLCML0GA.L692.0RG .lw,< lFyWAY �F c SYk f$ Ull 11"! P � ala^'%"sr-41- S .s. t ? Y��. �Y ,i- P •G � 'v-uy > MEN �,nmp Z` ; A-! . !-,I 1. =+bn-n-� i,}'iAIEIE--,,w;u 1;...�c�},:�•.'�✓ T� ° ULL "4i��* 'ri°-%' i�'i�! Iy�S'S�y �L � etia p \ _ °"'1��l,�C'; �F : �R G �" �`% i? fi''`b"� k�e c t .$�S� 4-JF.!RIi'�J'r. J� t-:r�}- an � � p ���1� � r`y�%� `^i ',�' ne.�. � �N� � =OR T IiE TRADE C_ ASSimOAT'.O"iS: CEts PNP ",9ASON: PI-ASTERc Li�Ll .v. .� t:vJl''✓'^.civ �-� .i a F2,_-ia. d of !0 dire_,,, of l.Jti �=7+J f . r:0 0r Jr' 2L.. I e^ fere Rev eed: o C Premium Concrete Services, Inc 712 Richmond Street Elkhart, IN 46516 574-264-0196 fax 574-266-5392 03/02/2022 To whom it may concern, Premium Concrete Services, Inc. has no federal, state or local tax delinquencies owed to any of the fore mentioned taxing bodies, nor has owed any in the past three years. Max Yeakey VP