Loading...
HomeMy WebLinkAboutOpening of Bids - Martin Luther King Jr. Center Demolition Proj No. 121-066 - Green Demolition Contractors, Inc.CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK CHECKLIST FOR BIDDERS Project Name Martin Luther King Jr. Demolition Project Project No. 121-066 For Bids Due December 13, 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 X or Bid Bond. Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely X executed. Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and X Certification of use of United States Steel Products or Foundry Products. Proof of M/WBE Utilization Plans [MBE -1.0 and WBE-1.01. Also provide Evidence of Good Faith Efforts Forms [MBE -2.0 and WBE-2.0] and M/WBE Contacted Forms [MBE -2.1 and X WBE-2.11. X Acknowledge Receipt of 3 Addendum(s) included with the bid. X All required additional information is included with the bid. Proposal statements and other affidavits all signed by the proper party with name either X printed or typed underneath signature. X This checklist submitted with the Bid. This checklist is provided for bidder's use documentation; however, it does not include all relieve the bidder of the need to read and complim Bidder: Green Demolition ContractoRg. By Authorized Signature: Print Name & Title: Michael J h. President in assuring compliance with required peci " ations requirements and does not e specifications. Version 09/29/2021 Contractor's Bid for Public Works - 1 Date: 13 -December -2022 CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK Project Name Martin Luther King Jr. Demolition Project Project No. 121-066 For Bids Due December 13, 2022 PART I (Must be completed for all bids. Please type or print) Date: 13 -December -2022 Bidder (Firm): Green Demolition Contractors, Incorporated Address: 523 Northbrook Drive City/State/Zip: Michigan City, IN 46360 Telephone Number: ( 312 ) 409-4771 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: City of South Bend Board of Public Works - Martin Luther King Jr Demolition Project #121-066 the City of South Bend, Indiana, in accordance with plans and specifications prepared by: VS Engineering and dated 08 -November -2022 for the sum of (enter the Total Bid as shown on the Proposal) Three Hundred Ninety Eight Thousand Eight Hundred Dollars { 398,800.00 (Enter sum of Total Base Bid plus Alternates shown on Proposal) (Numerical) The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the notice. Any addendums attached will be specifically referenced at the applicable. page. If additional units of material included in the contract AR needed, the cost of units rnuSf be the same as that shown in the original contract if accepted by the ity South Ben If the ids to be awarded on a unit basis, the itemization of the units shall be sho n on a sedate ch nt. /(Signature) !■ ch J. B gh, President _ (Printed 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, Vice President Jordan V. Gathers, Member Attest: Theresa Heffner, Clerk Version 09/29/2021 Contractor's Bid for Public Works - 2 THE CINCINNATI INSURANCE COMPANY CONTRACTOR (Name, legal status and address): SURETY (Name, legal status and principal place of business): Green Demolition Contractors, Inc. THE CINCINNATI INSURANCE COMPANY 4840 S. St Louis Avenue, Suite 100 6200 S. GILMORE ROAD FAIRFIELD, OHIO 45014-5141 Chicago, IL 60632 OWNER (Name, legal status and address): This document has important legal City of South Bend, Indiana consequences, Consultation with Board of Public Works an attorney is encouraged with respect to its completion or 227 W Jefferson Blvd - County -City Building Room 1316 modification. South Bend, IN 46601 Any singular reference to Contractor, Surety, Owner or BOND AMOUNT: 5% of Total Bid Amount other party shall be considered plural where applicable. PROJECT (Name, location or address, and Project number, if any): Wreck & Remove - Martin Luther King, Jr Demolition Project Project Number, if any: 121-066 The Contractor and Surety are bound to the Owner in the amount set forth above, for the payment of which the Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, as provided herein. The conditions of this Bond are such that if the Owner accepts the bid of the Contractor within the time specified in the bid documents, or within such time period as may be agreed to by the Owner and Contractor, and the Contractor either (1) enters into a contract with the Owner in accordance with the terms of such bid, and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a surety admitted in the jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof, or (2) pays to the Owner the difference, not to exceed the amount of this Bond, between the amount specified in said bid and such larger amount for which the Owner may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. The Surety hereby waives any notice of an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for an extension beyond the sixty (60) days. If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor. When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the Project, anyprovision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and provisions conforming to such statutory or other legal requirements 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 a ~"3day of /--:) t 13'y /l� 20 Michael Brough - President J THE CINCINNATI INSURANCE COMPANY (Srrr�ty} e (Witness) .. (Title) David S. Parrilli - Attorney -in -Fact The Company executing this bond vouches that this document con fonns to American Institute of Architects Document A310, 2010 Edition. S -2000 -AIA (11/10) PUBLIC THE CINCINNATI INSURANCE COMPANY THE CINCINNATI CASUALTY COMPANY Fairfield, Ohio POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That THE CINCINNATI INSURANCE COMPANY and THE CINCINNATI CASUALTY COMPANY, corporations organized under the laws of the State of Ohio, and having their principal offices in the City of Fairfield, Ohio (herein collectively called the "Companies"), do hereby constitute and appoint David L. Jennings; Amy C. Homer; Donald Petterson; Philip C. Reimer; Susan M. Preissing; Robert H. Walker; Doug O'Neill; George F. Manikas, Jr. and/or David S. Parrilli of Chicago, Illinois their true and legal Attorney(s)-in-Fact, each in their separate capacity if more than one is named above, to sign, execute, seal and deliver on behalf of the Companies as Surety, any and all bonds, policies, undertakings or other like instruments, as follows: Any such obligations in the United States, up to Twenty Million and No/100 Dollars ($20,000,000.00). This appointment is made under and by authority of the following resolutions adopted by the Boards of Directors of The Cincinnati Insurance Company and The Cincinnati Casualty Company, which resolutions are now in full force and effect, reading as follows: RESOLVED, that the President or any Vice President be hereby authorized, and empowered to appoint Attorneys -in -Fact of the Company to execute any and all bonds, policies, undertakings, or other like instruments on behalf of the Corporation, and may authorize any officer or any such Attorney -in -Fact to affix the corporate seal; and may with or without cause modify or revoke any such appointment or authority. Any such writings so executed by such Attorneys -in -Fact shall be binding upon the Company as if they had been duly executed and acknowledged by the regularly elected officers of the Company. RESOLVED, that the signature of the President or a Vice President and the seal of the Company may be affixed by facsimile on any power of attorney granted, and the signature of the Secretary and the Seal of the Company may be affixed by facsimile to any certificate of any such power and any such power of certificate bearing such facsimile signature and seal shall be valid and binding on the Company. Any such power so executed and sealed and certified by certificate so executed and sealed shall, with respect to any bond or undertaking to which it is attached, continue to be valid and binding on the Company. IN WITNESS WHEREOF, the Companies have caused these presents to be sealed with their corporate seals, duly attested by their President or a Senior Vice President this 19th day of December, 2018. CORPpRRiE coRPORarE - THE CINCINNATI INSURANCE COMPANY 5 E A L ` SEAL THE CINCINNATI CASUALTY COMPANY • OH10 6H19 STATE OF OHIO )SS: COUNTY OF BUTLER ) On this 19th day of December, 2018 before me came the above-named President or Vice President of The Cincinnati Insurance Com- pany and The Cincinnati Casualty Company, to me personally known to be the officer described herein, and acknowledged that the seals affixed to the preceding instrument are the corporate seals of said Companies and the corporate seals and the signature of the officer were duly affixed and subscribed to said instrument by the authority and direction of said corporations. Keith Co))161t, Attorney at Law Notary Public — State of Ohio My commission has no expiration date. Section 147.03 O.R.C. I, the undersigned Secretary or Assistant Secretary of The Cincinnati Insurance Company and The Cincinnati Casualty Company, hereby certify that the above is the Original Power of Attorney issued by said Companies, and do hereby further certify that the said Power of Attorney is still in full force and effect. Given under my hand and seal of said Companies at Fairfield, Ohio, this of �O?" -0•Wh�/!� e e BN-1457 (4/19) PART II (For projects of $100,000 or more — IC 36-1-12-4) These statements to be submitted under oath by each bidder with and as part of his/her/its bid. Attach additional pages for each section as needed. SECTION I EXPERIENCE QUESTIONNAIRE 1. Attach information regarding projects your organization has completed for the period of one (1) year prior to the date of the current bid. 2. Attach a listing of public works projects currently in process of construction by your organization. 3. Attach information regarding any failure to complete any work awarded to you and the location thereof. 4. Attach references from private firms for which you have performed work. SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE 1. Attach an explanation of your plan or layout for performing proposed work. (Examples could include a narrative of when you could begin work, complete the project, number of workers, etc. and any other information which you believe would enable the City of South Bend to consider your bid.) 2. Attach a listing of the names and addresses of all subcontractors (i.e. persons or firms outside your own firm who have performed part of the work) that you have used on public works projects during the past five (5) years along with a brief description of the work done by each subcontractor. 3. If you intend to sublet any portion of the work, attach the name and address of each subcontractor, equipment to be used by the subcontractor, and whether you will require a bond. However, if you are unable to currently provide a listing, please understand a listing must be provided prior to contract approval. Until the completion of the proposed project, you are under a continuing obligation to immediately notify the City of South Bend in the event that you subsequently determine that you will use a subcontractor on the proposed project. 4. Attach a listing of equipment you have available to use for the proposed project. 5. Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing your proposal? If not, attach an explanation for the rationale used which would corroborate the prices listed. SECTION III CONTRACTOR'S FINANCIAL STATEMENT Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial statement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to the City of South Bend awarding the contract must be specific enough in detail so that said City of South Bend can make a proper determination of the bidder's capability for completing the project if awarded. Version 09/29/2021 Contractor's Bid for Public Works - 3 When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit. CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON- DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS (Must be completed for all quotes and bids. Please type or print) STATE OF Indiana ) ) SS: La Porte 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 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 ("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. I, the undersigned bidder or agent as contractor on a public works project, understand my statutory obligations to the use of steel products or foundryproducts 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 Contractors 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 13th day of December 2022 Subscribed and sworn to before me this day of A, 20C�O, My Commission Expires Notary Pub is County of Residence La AnZL Version 09/29/2021 Contractors Bid for Public Works - 6 Ap.Y P$yry KELLYA LANG Notary Public, State of In LaPorte SEAL = County Commission plumber 659743 MdtA p`�r My Commission Expires October 26, 2030 Version 09/29/2021 Contractors Bid for Public Works - 6 :t 11 Ili t � BID/PROPOSAL Y CITY OF SOUTH BEND Project Name: Martin Luther King Jr. Demolition Project mi". Project Number: 121-066 For Bids Due: December 13, 2022 Contractor Name: Green Demolition Contractors, Incorporated BASE BID Item No. Description Quantity Unit Unit Price Total Amount 1 Demolition of the Martin Luther King Jr. 1 LF $60.00 $60.00/ LF 1 Center as described by the plans and 1 LS $398,800.00 $398,800.00 specifications. BASE BID TOTAL $398,800.00 ALTERNATE #1 Item No. Description Quantity Unit Unit Price Total Amount 1 Lead & Asbestos Abatement 1 LF $60.00 $60.00/ LF Bidder (Firm): Address: City/State/Zip: ALTERNATE #1 TOTAL $60.00/ LF Green Demolition Contractors, Incorporated Michigan City, IN Telephone Number: r (Printed Name of Person Signing) Version 09/29/2021 Contractor's Bid for Public Works - 7 x ifi , CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE -1.0 MBE UTILIZATION PLAN This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MBE participation. It is the bidder's sole responsibility to verify whether any listed minority-owned business meets the MBE qualifications. Project Number: 121-066 Project Name: Martin Luther King Jr. Demolition Bidder: Green Demolition Contractors, Inc Total Bid Amount: MBE Goal: 1.4% Page 1 of 1 Name &Address of MBE Primary Contact Person (Namerrelephone) Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of MBE Component Percentage of Total Bid/Proposal Trucks R Us / Kennedy Expressline 23300 IN -23 South Bend, IN 46601 K. Johnson 574-340-8471 Trucking and Hauling $7,976.00 2% 1 Submitted by: Michael J. Print Name President Version 09/29/2021 Contractor's Bid for Public Works - 8 13 -December -2022 Date 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: 121-066 Project Name: Martin Luther King Jr- Demolition Bidder: Green Demolition Contractors, Inc Total Bid Amount: WBE Goal: 4.6% Page 1 of 1 Name & Address of WBE Primary Contact Person CITY OF SOUTH BEND Dollar Amount of WBE MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM WBE-1.0 (Attach scope/schedule if you need additional space) WBE UTILIZATION PLAN RdProposall 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: 121-066 Project Name: Martin Luther King Jr- Demolition Bidder: Green Demolition Contractors, Inc Total Bid Amount: WBE Goal: 4.6% Page 1 of 1 Name & Address of WBE Primary Contact Person Scope of Work to be Performed Dollar Amount of WBE Percentage of Total (Namerrelephone) (Attach scope/schedule if you need additional space) Component RdProposall SanCorporation Sandra Smith Trucking & Hauling 1112 E Summit 219-299-6830 $20,000.00 5% Crown Point, IN 46307 Submitted by: Michael J. Brough, President Print Name Signa Version 09/29/2021 Contractors Bid for Public Works - 9 13 -December -2022 Date N. - CITY OF SOUTH BEND�] MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN ILEI. r, W' 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: 121-066 Project Name: Bidder- Contact Person: Address: City: Martin Luther King Jr. Demolition Project Green Demolition Contractors, Incorporated -Michael J. Brough, President 523 Northbrook Drive Michigan City State: Indiana Date: 13 -December -2022 Telephone: 312-409-4771 Zip: 46360 Email: M I vc -2-, 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*: I I EVIDENCE OF GOOD FAITH EFFORTS I 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.flov/idoa/. Version 09/29/2021 Contractor's Bid for Public Works - 10 GOOD FAITH EFFORTS TO OBTAIN MBE PARTICIPATION The bidder shall initial each item below, as evidence of its good faith efforts to obtain MBE participation in the awarded contract. I affirm that I reviewed the City of South Bend's Minority and Women Business Enterprise Inclusion Program Plan and the Indiana Department of Administration's certified list of Indiana Minority and Women Business Enterprises, found on their website (hftp://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 economically feasible units to facilitate MBE participation. 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. that I performed any and all necessary steps to provide written notices in a manner :)ffirm sonably calculated to inform MBEs of subcontracting opportunities and allowed time for MBEs to participate effectively. `sufficient /I affirm that I followed up on initial solicitations with interested MBEs. lEaffirm that I negotiated with interested MBEs in good faith, including providing such MBEs ith adequate information about the plans, specifications and other requirements of the subcontract. I ffirm that I have made good faith efforts to assist interested MBEs in obtaining bonding, nes of credit, or insurance as required by the City or the bidder, where appropriate. Version 09/29/2021 Contractor's Bid for Public Works - 10 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 - 11 l ffirm that I have made good faith efforts to assist interested MBEs in obtaining necessary equipment, supplies, materials, or related assistances or services, where appropriate. 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 - 11 µ1} err qE: CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN`S -i FORM WBE-2.0 EVIDENCE OF GOOD FAITH EFFORTS This completed form should be included as part of the Bids documents related to City of South Bend Public Works Projects requiring Good Faith Efforts to obtain MWBE participation. Project Number: 121-066 Date: 13 -December -2022 Project Name: Martin Luther Kina Jr. Demolition Project Bidder: Green Demolition Contractors, Incorporated Contact Person: Michael J. Brouah. President Address 523 Northbrook Drive Telephone- 312-409-4771 City: Michigan City State: Indiana Zip: 46360 Email: To determine whether a bided rha 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 - 12 EVIDENCE OF GOOD FAITH EFFORTS WBE LIST(S): The bidder reviewed 1) the City of South Bend's Minority and Women Business Enterprise Inclusion Program Plan; 2) the list of certified MWBEs provided by the City; and 3) the Indiana Department of Administration list of Minority and Women Owned Businesses (both certified and non -certified) found at: htt J/www.in. ov/idoa/. GOOD FAITH EFFORTS TO OBTAIN WBE PARTICIPATION The bidder shall initial each item below, as evidence of its good faith efforts to obtain WBE participation in the awarded contract. that I reviewed the City of South Bend's Minority and Women Business Enterprise Jarm sion Program Plan and the Indiana Department of Administration's certified list of na Minority and Women Business Enterprises, found on their website ://www.in.gqv/idoa). ffirm that I have made good faith efforts to select portions of the contract work to be Prformed by WBEs, including, where appropriate, breaking out contract work items into nomically feasible units to facilitate WBE participation. )l 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. eWBEs I affirm that 1 attended all pre-bid meetings scheduled by the City of South Bend to inform of contracting and subcontracting opportunities. ] affirm that I advertised in general circulation and/or trade association publications ncerming 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 111 r that I followed up on initial solicitations with interested WBEs. I affirm that I negotiated with interested WBEs in good faith, including providing such WBEs with adequate information about the plans, specifications and other requirements of the subcontract. affirm that I have made good faith efforts to assist interested WBEs in obtaining bonding, es of credit, or insurance as required by the City or the bidder, where appropriate. Version 09/29/2021 Contractor's Bid for Public Works - 12 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM WBE-2.0 EVIDENCE OF GOOD FAITH EFFORTS *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 - 13 I affirm that I have made good faith efforts to assist interested WBEs in obtaining E necessary equipment, supplies, materials, or related assistances or services, where appropriate. I affirm that I did not reject any WBEs as unqualified without sound business reasons based on a thorough investigation of their capabilities. CONTRACT RECORDS: The bidder has maintained the following records for each WBE that has bid on the subcontracting opportunity: 1. Name, address, and telephone number; 2. A description of information provided by the bidder or subcontractor; and 3. A statement of whether an agreement was reached, and if not, why not, including any reasons for concluding that the MWBE was unqualified to perform the job. *Proper demonstration of Good Faith Efforts requires your initials next to all of the above boxes. Any omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of South Bend reserves the right to request additional information. Version 09/29/2021 Contractor's Bid for Public Works - 13 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE -2.1 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 1 OF 1 Project Number: 121-066 MBE Participation Goal 1.4% Proiect�r : Martin Luther King Jr. Demolition Project Michael J. Brough, President 13 -December -2022 gn (Title) (Date) MBE Firm Trucks R Us - Kennedy Expressline Owner or Contact at MBE Firm K. Johnson Telephone: 574-340-8471 Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: Trucking/ Hauling RESULTS OF CONTACT WITH THE MBE FIRM: Interested in providing labor MBE Firm N/A 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 - 14 CITY OF SOUTH BEND r' MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE -2.1 1!4A 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 1 OF 1 Project Number: 121-066 WBE Participation Goal 4.6% Project Name: Martin Luther King Jr. Demolition Project Michael J. Brough, President 13 -December -2022 (Title) (Date) WBE Firm SanCorporation Owner or Contact at WBE Firm Sandra Smith Telephone: 219-299-6830 Fax: Email TYPE OF WORK SOLICITED FOR THIS PROJECT: Trucking and Hauling RESULTS OF CONTACT WITH THE WBE FIRM: SanCorporation agreed to and provided a price to provide services on this project as a WBE/ DBE Contractor_ WBE Firm N/A 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 - 15 P. d 1316 COUNTY -CITY BUILDING PHONE 574/235-9251 a x 227 W. JEFFERSON BOULEVARD IRO FAX 574/ 235-9171 SOUTH BEND, INDIANA 46601-1830 `w TDD 574/ 235-5567 CITY OF SOUTH BEND, JAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS Date: November 23, 2022 To: All Planholders From Theresa Heffner, Clerk, Board of Public Works Subject Addendum Number: 1 Project Name: Martin Luther King Jr. Center Demolition Project Project Number: 121-066 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: This addendum is being forwarded to you for the above referenced project. Please sign below and acknowledge receipt of this Addendum by faxing this sheet to the Board of Public Works at (574) 235-9171 within 48 hours of receipt. A copy MUST also be included with your bid package upon submittal. THIS AD1)EN[)UM MAY AFFECT YOUR BID. Notes: The attached documents are hereby added to the Specifications and Contract Documents and become a part of herein. Company: Green Demoliti Authorized Signature: Date: 06 -December -2022 Incorporated c , Michael Estimating From: Estimating Sent: Tuesday, December 6, 2022 2:35 PM To: rplantz@southbendin.gov Subject: 121-066 Martin Luther King Jr. Center Demo - Addendum #1 Acknowledgement Attachments: Martin Luther King Jr Center Demo Addendum 1 Acknowledgement.pdf Becca, Attached is our acknowledgement of Addendum #1. We will include a copy with the bid proposal as well. Have a great day! Thanks, Jason Bennett, PMP I ASHE Green Demolition Contractors, Inc. 4840 S. St. Louis Ave., Suite 100 Chicago, IL 60632 Cell: 773-858-5276 wmv. greend_emoli tion i n c.com 1316 CouNTY-CITY BUILDING L' PHONE 574/235-9251 227 W. JEFFERSON BOULEVARD �._ YACS 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: To: From Subject December 8, 2022 All Planholders Theresa Heffner, Clerk Board of Public Works Addendum Number: 2 Project Name: Martin Luther King Jr. Center Demolition Project Project Number: 121-066 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: 12 -December -2022 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: Green Demoliti Authorized Signature: Date: 12 -December -2022 Contractors, 1316 COUNTY -CITY BUILDING PHONE 574/235-9251 227 W. JEFFERSON BOULEVARD lRsS s FAX 574/ 235-9171 SOUTH BEND, INDIANA 46601-1830 TDD 574/ 235-5567 CITY OF SOUTH BEND, .TAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS Date: To: From Subject December 12, 2022 All Planholders Theresa Heffner, Clerk, Board of Public Works Addendum Number: 3 Project Name: Martin Luther King Jr. Center Demolition Project Project Number: 121-066 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: 12 -December -2022 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. TE HS ADDENDUM MAY AFFECT YOUR BID. Notes: The attached documents are hereby added to the Specifications and Contract Documents and become a part of herein. Company: Authorized Si Date: 12 -December -2022 Estimating From: Estimating Sent: Monday, December 12, 2022 4:23 PM To: Rebecca Plantz Subject: 121-066 Martin Luther King Jr. Center Demo - Addendum #1 Acknowledgement Attachments: Martin Luther King Jr Demolition Add 2 and 3 Acknowledgement.pdf Good Afternoon Becca, Attached is our acknowledgement of addendums #2 & 3 received today. Thanks, Jason Bennett, PMP I ASHE Green Demolition Contractors, Inc. 4840 S. St. Louis Ave., Suite 100 Chicago, IL 60632 Cell: 773-858-5276 www.green demol i tioni nc. ccm From: Rebecca Plantz <rplantz@south bend in.gov> Sent: Wednesday, December 7, 2022 11:18 AM To: Estimating <estimating@greendemolitioninc.com> Subject: RE: 121-066 Martin Luther King Jr. Center Demo - Addendum #1 Acknowledgement Received and passed to administrative staff, thank you! Becca Plantz Project Engineer City of South Bend 227 West Jefferson Boulevard South Bend. Indiana 46601 (574)235-5998 From: Estimating <estimating@greendema!itioninc.com> Sent: Tuesday, December 6, 2022 3:35 PM To: Rebecca Plantz <r lantz southbendin. ov> Subject: 121-066 Martin Luther King Jr. Center Demo - Addendum #1 Acknowledgement Becca, Attached is our acknowledgement of Addendum #1. We will include a copy with the bid proposal as well. Have a great day! Thanks, Jason Bennett, PMP I ASHE Green Demolition Contractors, Inc. GREEN DEMOLITION CONTRACTORS, INC. 523 Northbrook Dr Michigan City, IN 46360 312-409-4771 office December 12, 2022 City of South Bend 227 West Jefferson Boulevard City County Building 1316 South Bend, Indiana 46601 Re: Martin Luther King Jr. Center Demolition Project — Project # 121-066 CONTRACTORS CONFIDENTIAL INFORMATION Green Demolition Contractors, Incorporated respectfully requests that its Financial Statement/ Information provided with this bid be shared only with those parties within the City of South Bend Indiana. If and to the greatest extent possible, please do not post Green Demolitions Financial Statement/ Information to the public. Thank You, Michaele.Bough, President Recycling Today For A Greener Tomorrow" Q�n `._ CONTRACTOR'S BID FOR PUBLIC WORK - FORM 96 )PI"' State Form 52414 (R2 / 2-13) / Form 96 (Revised 2013) liPrescribed by State Board of Accounts PART (To be completed for all bids. Please type or print) Date (month, day, year), December 13, 2022 1. Governmental Unit (Owner): City. of South Bend 2. County St. Joseph County 3. Bidder (Firm): Green Demolition Contractors Incorporated LLC Address: 523 Northbrook Drive City/State/ZlPcode: Michigan City, Indiana 46360 4. Telephone Number: 312-409-4771 5. Agent of Bidder (if applicable): Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the public works project of City of South Bend Indiana (Governmental Unit) in accordance with plans and specifications prepared by VS Engineering Three Hundred Ninety Eight Thousand Eight Hundred Dollars and dated Nov 8, 2022 for the sum of $ 398,800.00 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 governmental unit. If the bid is to be awarded on a unit basis, the itemization of the units shall be shown on a separate attachment. The contractor and his subcontractors, if any, shall not discriminate against or intimidate any employee, or applicant for employment, to be employed in the performance of this contract, with respect to any matter directly or indirectly related to employment because of race, religion, color, sex, national origin or ancestry. Breach of this covenant may be regarded as a material breach of the contract. CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS (If applicable) I, the undersigned bidder or agent as a contractor on a public works project, understand my statutory obligation to use steel products made in the United States (I.C. 5-16-8-2). 1 hereby certify that I and all subcontractors employed by me for this project will use U.S. steel products on this project if awarded. I understand that violations hereunder may result in forfeiture of contractual payments. Have you ever failed to complete any work awarded to you? List references from private firms for which you have performed work. See attached SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE If so, where and why? Explain your plan or layout for performing proposed work. (Examples could include a narrative of when you could begin work, complete the project, number of workers, etc. and any other information which you believe would enable the governmental unit to consider your bid.) See attached 2. Please list the names and addresses of all subcontractors (i. e. persons or firms outside your own firm who have performed part of the work) that you have used on public works projects during the past five (5) years along with a brief description of the work done by each subcontractor. See Attached If you intend to sublet any portion of the work, state the name and address of each subcontractor, equipment to be used by the subcontractor, and whether you will require a bond. However, if you are unable to currently provide a listing, please understand a listing must be provided prior to contract approval. Until the completion of the proposed project, you are under a continuing obligation to immediately notify the governmental unit in the event that you subsequently determine that you will use a subcontractor on the proposed project. See attached 4. What equipment do you have available to use for the proposed project? Any equipment to be used by subcontractors may also be required to be listed by the governmental unit. See attached 5. Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing your proposal? If not, please explain the rationale used which would corroborate the prices listed. See attached SECTION III CONTRACTOR'S FINANCIAL STATEMENT Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial statement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to the governing body awarding the contract must be specific enough in detail so that said governing body can make a proper determination of the bidder's capability for completing the project if awarded. SECTION IV CONTRACTOR'S NON — COLLUSION AFFIDAVIT The undersigned bidder or agent, being duly sworn on oath, says that he has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to include anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. He further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale. SECTION V OATH AND AFFIRMATION I HEREBY AFFIRM UNDER THE PENALTIES FOR PERJURY THAT THE FACTS AND INFORMATION CONTAINED IN THE FOREGOING BID FOR PUBLIC WORKS ARE TRUE AND CORRECT. Dated at St. Joseph County STATE OF IN COUNTY OF LaPorte Green this 13 th day of December Molition qa! tTgtor"eafiporated LLC of Organization) Michael Brough, Presdient } ) ss (Title of Person Signing) ACKNOWLEDGEMENT 2022 Before me, a Notary Public, personally appeared the above-named Michael Brough and swore that the statements contained in the foregoing document are true and correct. Subscribed and sworn to before me this 13th day of December 2022 My Commission Expires: 10/26/2030 County of Residence: LaPorte Notary Public KELLY A LANG S,.SFKY.pG� 4`y„' � a Notary Public, State of Indiana LaPorte County SEAL ] = € Commission Number 659743 My Commission Expires 3':�+Vpq`Nro October 26, 2030 Part of State Form 52414 (R2 / 2-13) / Form 96 (Revised 2013) Green Demolition Contractors Incorporated LLC (Contractor) 523 Northbrook Drive (Address) Michigan City, Indiana FOR PUBLIC WORKS PROJECTS OF City of South Bend Indiana 227 Jefferson Blvd South Bend, IN Filed Action taken GREEN DEMOLITION CONTRACTORS INCORPORATED 523 Northbrook Drive Michigan City, IN 46360 312-409-4771 Main December 13, 2022 City of South Bend Department of Public Works 227 Jefferson Boulevard South Bend, Indiana 46601 Re: Martin Luther King Jr. Center Demolition Project # 121-066 Section III Green Demolition Contractors, Inc. is committed to exceeding the Goal from a Section 3 firm. Green Demolition Contractors, Inc. currently has a relationship with Kennedy Express Line 2330 State Road 23 South Bend, Indiana MBE, WBE, and Section 3 Certified. It is the intent of Green Demolition Contractors, Inc. to utilize Kennedy Express Line for disposition of debris and if applicable, recycle / reuse of any materials being deemed as such. Thank you, Michael Brough, President Green Demolition Contactors, Inc. "Recycling Today For A Greener Tomorrow" GREEN DEMOLITION CONTRACTORS INCORPORATED 523 Northbrook Drive Michigan City, IN 46360 312-409-4771 Main Demolition Plan December 13, 2022 City of South Bend Department of Public Works 227 Jefferson Boulevard South Bend, Indiana 46601 Re: Martin Luther King Jr. Center Demolition Project # 121-066 Green Demolition Contractors Incorporated will procure Insurance Certificates, Bonding and all other Start-up Paperwork i.e. Permits, etc necessary to Mobilize and Secure the Facility upon Contract Award and Notice to Proceed as follows: Coordination and Verification of Utility Disconnects Verification of Abatement Removals if applicable Salvage per Specifications Demolish and Remove Debris from Buildings Demolish and Remove Concrete Backfill per specifications Remove all Debris from Site and Dispose of at a Legal Landfill Perform Site Restoration Work per specifications Demobilize Respectfully submitted, Michael Brough, President Green Demolition Contractors, Inc. "Recycling Today For A Greener Tomorrow" GREEN DEMOLITION CONTRACTORS INCORPORATED 523 Northbrook Drive Michigan City, IN 46360 312-409-4771 Main December 13, 2022 City of South Bend Department of Public Works 227 Jefferson Boulevard South Bend, Indiana 46601 Re: Martin Luther King Jr. Center Demolition Project # 121-066 Green Demolition Contractors Incorporated proposed to complete their work utilizing the following Number of Men and Equipment: Two (2) Union Operating Engineers Three (3) Union Laborers One (1) Union Foreman Two (2) Excavators with Grapples One (1) S300 Bobcat with Grapple Respectfully submitted, Michael Brough, President Green Demolition Contractors, Inc. "Recycling Today For A Greener Tomorrow" GREEN DEMOLITION CONTRACTORS, INC. 523 Northbrook Drive Michigan City, IN 46360 312-409-4771 main Section II Plan and Equipment Questionnaire 1. Green Demolition Contractors Incorporated LLC will mobilize at the site and perform inspections. We will confirm utilities are disconnected, abatement is complete, and the structure is free of pedestrians. Then, we will demolish the structure. We will salvage and recycle materials to meet deconstruction qualifications if applicable and load out debris. Concrete and brick will be demolished and loaded out. We will backfill and compact site and deliver and spread black dirt. This will be repeated at each property. After all properties are complete, we will confirm the seeding at each property. 2. San Corporation 1112 E. Summit Crown Point, IN Trucks R Us / Kennedy Expressline 2330 State Road 23 South Bend, IN Prairieview / Waste Management 15505 Shively Wyatt, IN 3. Not Applicable 4. Two CAT 320 Excavators Two T-300 Skid Steers (1) One Mack Semi 65 yard Roll Off (1) One Mack 6 Wheeler 40 yard Roll Off (1) One Mack Semi Low Boy 5. Yes Disposal / Hauling Disposal/Hauling Landfill See Equipment List attached "Recycling Today For A Greener Tomorrow" GREEN DEMOLITION CONTRACTORS INCORPORATED 523 Northbrook Drive Michigan City, IN 46360 312-409-4771 Main December 13, 2022 City of South Bend Department of Public Works 227 Jefferson Boulevard South Bend, Indiana 46601 Re: Martin Luther King Jr. Center Demolition Project # 121-066 Public Works Projects in Progress Green Demolition Contractors Incorporated is currently under contract for the following Public Works Projects: City of Springfield Railroad Removal $ 399,000.00 Spring 2023 Wreck and Remove Complete various structures. Site Restoration. Respectfully submitted, Michael Brough, President Green Demolition Contractors, Inc. "Recycling Today For A Greener Tomorrow" BUSINESS INFORMATION HOLLI SULLIVAN INDIANA SECRETARY OF STATE 12/12/2022 05:58 PM Business Details Business Name: GREEN DEMOLITION CONTRACTORS Business ID: 2015061100177 INCORPORATED Entity Type: Domestic Limited Liability Company Business Status: Active Creation Date: 06/11/2015 Inactive Date: Principal Office Address: 523 NORTHBROOK DRIVE, MICHIGAN Expiration Date: Perpetual CITY, IN, 46360, USA Jurisdiction of Formation: Indiana Business Entity Report Due 06/30/2023 Date: Years Due: j'G,'vWWNg Person Information Title Name Address President Michael Brough 523 Northbrook Drive, Mich City, IN, 46360, USA IRegistered Agent Information Type: Individual Name: MICHAEL BROUGH Address: 523 NORTHBROOK DRIVE, MICHIGAN CITY, IN, 46360, USA CIHNCINNATI INSURANCE COMPANIES December 2022 The Cincinnati Insurance Company • The Cincinnati Indemnity Company The Cincinnati Casualty Company ■ The Cincinnati Specialty Underwriters Insurance Company The Cincinnati Life Insurance Company RE: Green Demolition Contractors Inc. — Bonding Capacity To Whom It May Concern. The Cincinnati Insurance Company (AM Best Rating of A+XV) provides surety bonding credit to Green Demolition Contractors Inc. They are one of our finest accounts and we highly recommend them. We currently have $5,000,000 single job/$10,000,000 aggregate bond program available for this firm. Should a situation merit, we would consider requests beyond these parameters as well. Any specific request for bonds will be underwritten on its own merits and any arrangement for bonds required by any contract is a matter between Green Demolition Contractors Inc.and the surety and we assume no liability to you or your third parties, if for any reason we do not execute these bonds. Feel free to contact us with any questions you may have. Sincerely, Natalie Koster Attorney -in -Fact Field Director Surety Natalie—Koster@cinfin.com Mailing Address:P.O. Box 145496 • Cincinnati, Ohio 45250-5496■Headquarters: 6200 S. Gilmore Road • Fairfield, Ohio 45014-5141 cinfin.corrr 513-870-2000 REVIEW REPORT FOR THE YEAR ENDED DECEMBER 31, 2021 Selden Fox Accounting for your future Green Demolition Contractors, Inc. Review Report For the Year Ended December 31, 2021 Table of Contents Independent Accountant's Review Report Financial Statements: Balance Sheet Statement of Income Statement of Stockholder's Equity Statement of Cash Flows Notes to the Financial Statements Supplementary Information: Independent Accountant's Review Report on Supplementary Information Schedule of Cost of Contract Revenues Earned Schedule of Operating Expenses 1 2 3 4 5 6-16 17 18 19 S; Accounting for your future 619 Enterprise Drive Oak Brook, Illinois 60523 1 www.seldenfox con -1 p 630.954.1400 f 630.9541327 emailoseldenfox.com INDEPENDENT ACCOUNTANT'S REVIEW REPORT Mr. Michael Brough Green Demolition Contractors, Inc. Chicago, Illinois We have reviewed the accompanying financial statements of Green Demolition Contractors, Inc., which comprise the balance sheet as of December, 31, 2021, and the related statements of income, stockholder's equity and cash flows for the year then ended, and the related notes to the financial statements. A review includes primarily applying analytical procedures to management's financial data and making inquiries of company management. A review is substantially less in scope than an audit, the objective of which is the expression of an opinion regarding the financial statements as a whole. Accordingly, we do not express such an opinion. Management's Responsibility for the Financial Statements Management is responsible for the preparation and fair presentation of these consolidated financial statements in accordance with accounting principles generally accepted in the United States of America; this includes the design, implementation, and maintenance of internal control relevant to the preparation and fair presentation of consolidated financial statements that are free from material misstatement whether due to fraud or error. Accountant's Responsibility Our responsibility is to conduct the review engagement in accordance with Statements on Standards for Accounting and Review Services promulgated by the Accounting and Review Services Committee of the AICPA. Those standards require us to perform procedures to obtain limited assurance as a basis of reporting whether we are aware of any material modifications that should be made to the financial statements for them to be in accordance with accounting principles generally accepted in the United States of America. We believe that the results of our procedures provide a reasonable basis for our conclusion. We are required to be independent of Green Demolition Contractors, Inc. and to meet our other ethical responsibilities, in accordance with the relevant ethical requirements related to our review. Accountant's Conclusion Based on our review, we are not aware of any material modifications that should be made to the accompanying financial statements in order for them to be in accordance with accounting principles generally accepted in the United States of America. &e0ko 4rg, Ari.. November 17, 2022 mgiworldwide Green Demolition Contractors, Inc. Notes to the Financial Statements 1. Nature of Operations Green Demolition Contractors, Inc. (Company) is a demolition contractor engaged in the deconstruction of industrial, commercial, municipal and privately -owned buildings primarily in the greater Chicagoland area. The work is generally performed under fixed price contracts. The length of contracts varies and generally does not extend beyond one year. The Company commenced operations on July 30, 2007. 2. Summary of Significant Accounting Policies Use of Estimates — Management uses estimates and assumptions in preparing these financial statements in accordance with accounting principles generally accepted in the United States of America (GAAP). Those estimates and assumptions affect the reported amounts of assets and liabilities, the disclosure of contingent assets and liabilities, and the reported revenues and expenses. Actual results could vary from the estimates that were used. Significant estimates used in the preparation of these financial statements include the following: The Company has estimated an allowance for doubtful accounts of $140,000 at December 31, 2021. This conclusion is based on the status and age of contracts receivable. The Company has many contracts in various stages of completion. The Company must make estimates of the extent and progress towards completion, contract revenue and contracting costs, and it uses the cost to cost method of accounting for all of its long-term contracts. For the above mentioned estimates, it is reasonably possible that the recorded amounts could significantly change in the near future, as new information is available. Revenue Recognition — Demolition work is a single performance obligation that is satisfied over time. The Company recognizes contract revenue for financial reporting purposes over time. Progress toward completion of the Company's contracts is measured by the percentage of cost incurred to date to estimated total costs for each contract. The Company tracks demolition work by customer industry. The approximate percentages of customer revenues to total demolition revenue was school districts 17%, commercial businesses 5%, governments 43%, and healthcare 35%. As part of the Company's demolition work, the Company also salvages certain material to sell for an additional revenue stream. This revenue is recognized at a certain point in time upon sale. Total scrap revenue represents approximately 18% of total revenue. sm Green Demolition Contractors, Inc. Notes to the Financial Statements (cont'd) 2. Summary of Significant Accounting Policies (cont'd) Revenue Recognition (cont'd) This method is used because management considers total cost to be the best available measure of progress on contracts. Because of inherent uncertainties in estimating costs, it is at least reasonably possible that the estimates used will change significantly within the near term. Contracts are fixed price. The payment terms and conditions in customer contracts vary. Payment typically is due over time in installments, based on project phases as specified in the contracts. Final payment is due when all performance obligations identified in the contract are completed. Cost Recognition — Contract costs include all direct material, subcontractor and labor costs and those material indirect costs related to contract performance. Provisions for estimated losses, if any, on uncompleted contracts are made in the period in which such losses are determined. Changes in job performance, job conditions, and estimated profitability, including those arising from contract penalty provisions, and final contract settlements may result in revisions to costs and income and are recognized in the period in which the revisions are determined. Mobilization costs incurred that include the initial costs to move equipment, personnel and supplies to a job site are insignificant. The contract asset represents revenues recognized in excess of amounts paid or payable (contract receivables). The contract liability represents the Company's obligation to perform on completed contracts with customers for which the Company has received payment or for which contract receivables are outstanding. Contract Receivables — Contract receivables from performing construction projects are carried at their estimated collectible amounts. When payment of the retainage is contingent upon the Company fulfilling its obligations under the contract it does not meet the criteria to be included in contracts receivable and remains in the contract's respective contract asset or contract liability, determined on a contract -by -contract basis. Retainage for which the Company has an unconditional right to payment that is only subject to the passage of time are included in contracts receivable. The Company provides an allowance for doubtful collections which is based upon a review of outstanding receivables, historical collection information, and existing economic conditions. Payments on invoices are due 30 days after the issuance of the invoice. Contract retentions are due 30 days after completion of the project and acceptance by the owner. Delinquent receivables are written off based on individual credit evaluations and specific circumstances of the customer. At December 31, 2021, the Company considered $140,000 of contract receivables to be uncollectible and is recognized as an allowance for doubtful accounts. Property and Equipment — Property and equipment are recorded at cost less accumulated depreciation. Assets are depreciated over their estimated useful lives that range between five and seven years. Costs of maintenance and repairs are charged to expense when incurred. -7- Green Demolition Contractors, Inc. Notes to the Financial Statements (cont'd) 2. Summary of Significant Accounting Policies (cont'd) Paycheck Protection Program Revenue — The Company accounts for Paycheck Protection Program loan proceeds as a grant under Accounting Standards Codification (ASC) Subtopic 958-605, which allows for revenue to be recognized when conditions surrounding the cancellation of a liability, such as a forgivable loan have been substantially met or have been explicitly waived by the resource provider. In March 2021, the Company received $653,764 of proceeds in the form of a potentially forgivable loan under the Paycheck Protection Program (PPP) under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). ' Under the terms of the PPP, as subsequently modified by the Paycheck Program Flexibility Act (PPPFA), principal and interest payments are deferred until a forgiveness determination is made and any amounts not forgiven can be repaid over two years at an annual interest rate of 1%. Conditions of forgiveness include incurring qualified expenditures within an 8 -week or maximum 24 -week timeframe beginning with the date the loan proceeds are received, maintaining payroll levels on an employee -by -employee basis, and maintaining headcount, within PPP parameters. The Company believes they incurred $653,764 of qualified expenditures over a 24 -week period and that the conditions relating to maintaining payroll levels were substantially met as of December 31, 2021. As such, the Company has recognized the related forgiveness as Paycheck Protection Program revenue in the accompanying financial statements. Subsequent to year end, in March 2022, the Company received formal notification that their application for forgiveness had been approved by the United States Small Business Administration. The application for loan forgiveness is subject to audit by the Internal Revenue Service. Any disallowed credits as a result of an audit would become a liability to the Company. Variable Interest Entities — The Company does not to evaluate qualifying entities, who are under common control, under FASB Accounting Standards Update (ASU) 2018-17, Consolidation (Topic 810). Targeted Improvements to Related Party Guidance for Variable Interest Entities, which provides private companies with an accounting alternative for certain commonly controlled entities. Income Taxes — The Company with consent of its stockholder elected to be taxed under the Internal Revenue Service as an S Corporation. In lieu of corporate income taxes, the stockholders of an S corporation are taxed on their proportionate share of the Company's taxable income or loss. Therefore, no provision or liability for current federal income taxes has been included in the financial statements. The Company will be subject to Illinois replacement tax at a rate of 1.5% of net taxable income. Selden Fox Accounting for your future 619 Enterprise Drive I Oak Brook, Illinois 60523 www.seldenfox.coni p 630.9541400 ! f 630 954.1327 i email �seldenfox.com INDEPENDENT ACCOUNTANT'S REVIEW REPORT ON SUPPLEMENTARY INFORMATION Mr. Michael Brough Green Demolition Contractors, Inc. Chicago, Illinois Our report on our review of the basic financial statements of Green Demolition Contractors, Inc. for the year ended December 31, 2021, appears on page 1. The objective of that review was to perform procedures to obtain limited assurance as a basis for reporting whether we were aware of any material modifications that should be made to the financial statements for them to be in accordance with accounting principles generally accepted in the United States of America. The accompanying supplementary information of the Schedule of Cost of Contract Revenues Earned and Schedule or Operating Expenses is presented for purposes of additional analysis and is not a required part of the basic financial statements. The supplementary information is the responsibility of management and was derived from, and relates directly to, the underlying accounting and other records used to prepare the financial statements. The supplementary information has been subjected to the review procedures applied in our review of the basic financial statements and we are not aware of any material modifications that should be made to the supplementary information. We have not audited the supplementary information and do not express an opinion on such information. &&& 4r�' &. November 17, 2022 17- GREEN DEMOLITION CONTRACTORS, INC. 523 Northbrook Drive Micbigan City, IN 46360 312-409-4771 office Incorporated in the State Of Illinois in the Year 2007 References with Cor1tracg Qmovnt� Northern Indiana Commuter Transportation District (NICTD) 333 East US Highway 12 Chesterton, Indiana Mr. Jeff Decker 219-926-5744 Double Track North ypest Indiana Project Contract 1 Doable Track Northwest Indiana Project Contract 2 $1, 709, 712.00 S 898,165 00 Wreck and Remove Various Residential and Commercial Properties Backfill and Restore Site. Tonn & Blank Construction 1623 Greenwood Avenue Michigan City, IN 46360 219-878-6289 Mr. Curt Cipares Franciscan health Hospital Michigan City $ 2,145, 745.00 Wreck and Removal of an Existing Six Story 500,000 square feet Operational Hospital Building Including Tower. Self perform on site Concrete Crushing/Recycling, Reduced and Repurposed to be used as Suitable Compacted Backfill Materia] for site. Manage front end of demolition project i.e. coordination of all utility disconnects, Environmental Remediation, etc. Perform all HSMS removals. Dismantle existing 8 story building from portion of operational hospital to remain. Wreck and remove approx. 300,000 sf of remaining building. 90% of Demolition debris recycled throughout the process all remaining debris hauled off site. Backfill and restore site. Vision Construction & Consulting 1733 N. 33rd Stone Park, Illinois 60165 Mr. bark Weiner 708-488-1926 J hIorton Sterling SD 201 High School Knolvierdge Center S 3,S70,75-5. 00 Cath; �:N T_li%E1\ GLR OI` COO'NTRAC` ORS, LI C. 523 NovRhbrook Drive Michigan City, IN 46360 312-409-4771 office Interior Selective and Exterior W1eck Removals of an xisting high School wilding Perform interior demolition throughout the entire Nigh School. Mork was performed during off hours weekends, holidays and summer vacation and at times during normal school day while students were present. GDC performed extensive Structural Demolition and Shoring on an as needed basis as this school was 130 years old with unforseens. City of South Bend Indiana 1316 County -City Bldg. Rm. 1316 South Bend, Indiana 46601 Mr. Toy Villa 574-235-5920 Demolition of 10.3 Abandoned Properties 51,609,090.00 Scope of Work. Wreck and Remove Complete with Grading and Seeding of 103 Properties Wight Co. 2500 Frontage Road Darien, Illinois 60156 630-969-7000 Downers Grove SD 99 Architectural Renovations Architectural/Structural Removals of Auditorium $1,096,964 00 Perform heavy Structural Demolition for the removal of an Existing Auditorium that was built into the school bldg on three elevations. Extensive dismantling and shoring took place to ensure the school and children were not affected throughout the course of the school day. Performed selective and Structural Demolition throughout the school. Brown & Momen, Inc. 823 E. Drexel Square Chicago, IL 60615 Mr. David Clark 312-758-0770 Marshall Meld Gallen Apartments Building 5 Scope of Work: Interior selective removals of all finishes multi story level IUD wilding $197444,000.00 Osman Construction 70 West Seegers Road Arlington Heights, Illinois 60005 847-593-2705 Mr. Tim Silvetti Rod'eway Iran Hotel Skokie Illinois GREEN DEMOLITION CONTRACTORS, INC. 523 Northbrook Drove Michigan City, IN 46360 312-409-4771 office $ 863, 425.00 Complete Wreck and Removal of 4 Story Hotel, Pool, Restaurant, Parking Reck, Including Site Restoration Doherty Construction 163 Ido Valley Hill Road Woodstock, Illinois 60098 Mr. Vern Anderson 815-334-8500 Fest Leyden High School Wreck .removal Portion of School Building Selective Interior Demolition Cook County Land Runk Authority 69 W. Washington Smite 2938 Chicago, IL 60602 Mr. Mustafaa Saler 312-603-8015 Scope of Work: $ 719,375.00 $ 9259000000 Open Ended Contract ongoing through the depletion of Grants/Funds Demolition of Abandoned / Vacant Homes throughout Chicago and Cook County. City of ChicagolWight Co. 2500 North Frontage Road Darien, IL 60561 Dennis Podzimek 630-918-9428 CiYY Ilfall Space C9lPsOU(lldtioFa1Mayor's Floor Scope of Work: $1,-98,800 00 Multiple Interior Floor Selective Removals of 100,000 s.f Finishes and Furnishings. Working in strict adherence with Municipal Building — Security Procedures Rockford Coustructiom Grand Rapids, Ml 49508 Brock Burgess 616-437-4226 LaPorte, In Meijer Store Scope of Work. GREEN DEMOLITION! CONTRACTORS, INC. 523 Northbrook Drive Michigan City, IN 46360 312-409-4771 office S 787, 000 00 Complete 100% gut re -habilitation project with Bobcat machines of an existing Big Pox facility consisting of ceilings, drywall partition walls, storefronts, facades, floorings, concrete removals. KEY. and portion of structure removals. Tenn & Blank Construction LLC 1623 Greenwood Ave. Michigan City, IN 46360 Joel Gonzales 219 877-8174 Uptoivn AHis tLofis $ 611,086.00 Michigan City, IN Scope of Work. Interior Selective Finish / Abatement and Structural removals of Multi Level Facility Barton Malow Company 150 N Upper Wacker Br 41650 Chicago, IL 60606 Brian Courtney 312-281-0821 Argonne National Laboratory $ 212,000.00 Argonne National Lab — MI/eHals Engineering Building 370 Building 360 Expansion Scope of Work: Green Demolition performed wreck removals within Building 370 adjacent to an ongoing Phosphorous Experiment working in direct conjunction with electric, communications systems, sprinkler systems, natural gas and steam while performing lead and asbestos abatement. Green Demolition performed a Building Wreck within 10 feet of a Linear Accelerator without service interruptions to the electric, water, sewer, natural gas, steam and communications systems. '4 g CERTIFICATE OF LIABILITY INSURANCE #16..,10/10/2022 DATE (MMIDDIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER HANE David S Parrilll Parrilli, David ,AugPHOme Noext,(312)621-5182 Nc Naz (312)621-2288 E' A L dparrilli@rockwoodco corn ADDRESS: The Rockwood Company INSURER S) AFFORDING COVERAGE NAIC N 20 N Wacker Drive, Suite 600 INSURERA : Navigators Specially Ins Co. 36056 Chicago IL 60606 INSURED INSURER B: Slarstone National Insurance Co. 25496 INSURER C: Hallmark Specially Insurance Co- 26808 Green Demolition Contractors, Inc INSURER 0: 4840 S St Louis Ave Ste 100 INSURER E: CLAIMS -MADE X OCCUR 1 INSURER F Chicago IL 60632 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE IMI POLICY NUMBER (iYl __0lYYYY [MAfR]EHYYYYJ_ LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR PREMl4 SjEaosrur¢ae¢} $ 50,000 MED EXP (Any one person) $ 5,000 A X X CE22CGL1326961C 10101/2022 10/01/2023 PERSONAL &ADV INJURY $ 1,000,000 GEN,, AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ®PRG ❑ Loc PRODUCTS - COMPIOP AGG $ 2,000,000 $ OTHER AUTOMOBILE LIABILITY IEa 4c[10atHS L LIMI1 $ 1,000,000 BODILY INJURY (Per personl $ ANY AUTO A OWNED SCHEDULED X X CE22CGL1326961C 10/01/2022 10/01/2023 BODILY INJURY (Per accidw L) $ AUTOS ONLY AUTOS PRO'ER1YtMMAQE I Nor Iden $ NON -OWNED HIRED rx AUTOS ONLY AUTOS ONLY $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 B 7 EXCESS LIAR CIAIMS-MADE 59095B22AALI 10/0112022 10101/2023 DFs JX RETENTION S 10.000 $ _ WORKERS COMPENSATION STATUTE EFIH AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EX ECUTIVE E -L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory In NHI E.L DISEASE - EA EMPLOYEE S It yes, describe under DESCRIPTION OF OPERATIONS below F.L DISEASE- POLICY LIMIT $ Each Occurrence 5,000,000 Excess Umbrella Liability C 79EX-000708922-00 10101/2022 1010112023 Aggregate 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: 7042 Lanphier High School - Additions and Renovations - 1300 N 11 th St, Springfield, IL 62702 Additional insureds with respect to General Liability and Hired & Non Owned Auto Liability (Umbrella follows form) on a Primary & Non Contributory basis when required by written contract per ISO Forms CG 2010 10/01 and CG 2037 10/01 (attached) for work performed by Green Demolition Contractors, Inc. A Waiver of Subrogation in favor of Additional Insureds with respect to General Liability and Hired & Non Owned Auto Liability (Umbrella follows form) when required by written contract is included per ISO form CG 2404 (05/09): Harold O'Shea Builders, Inc (GC), Springfield Public School District 186 (Owner); and BLDD (Architect) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Harold O'Shea Builders, Inc ACCORDANCE WITH THE POLICY PROVISIONS. General Contractor AUTHORIZED REPRESENTATIVE 3401 Constitution Drive w' Springfield IL 62711 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CE22CGL1326961C COMMERCIAL GENERAL LIABILITY CG 20 10 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person or organization for whom you are performing operations during the policy period have agreed in writing in a contract or agreement be added as an additional insured on your policy (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II - Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to "bodily in- jury" or "property damage" occurring after: SAMPLE (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the addi- tional insured(s) at the site of the cov- ered operations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another con- tractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 10 01 © ISO Properties, Inc., 2000 Page 1 of 1 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: CE22CGL1326961C CG 20 37 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED w OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following - COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person or organization for whom you are performing operations during the policy period have agreed in writing in a contract or agreement be added as an additional insured on your policy And Description of Completed Operations: Additional Premium: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section 11 - Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" at the location designated and described in the schedule of this endorsement performed for that insured and included in the "products -completed operations hazard". SAMPLE CG 20 37 10 01 © ISO Properties, Inc., 2000 Page 1 of 1 POLICY NUMBER: CE22CGLI326961C COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any person or organization for whom you are performing operations during the policy period have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above, SAMPLE CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 DATE (MMIODNYYYI AC -COR", 0912712022 `� CERTIFICATE OF LIABILITY INSURANCE Acct#:2494a6 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT LOCKTON COMPANIES, LLC PHONE FAX 2100 ROSS AVE., SUITE 1400 UVC, No, Ea11: 214.771-4411 (AIC, Na}: DALLAS, TX 75201 E-MAILADDRESS W C.&R ESO URCIN DEnCI ECOM INSURED GREEN DEMOLITION CONTRACTORS INC. 4840 S ST LOUIS AVE SUITE 100 CHICAGO, IL 60632 INSURER{S} AFFORDING COVERAGE NAI[: n IN RURER Al In (TOM n Hy l ll Buren ca Co. of Norah America 43575 INSURER B tNS UR ER C . INSU R ER D : INSURER E COVFRACCFR C_I`RTiVlr ATK AIIIMFkr D- o1=111¢1nAt ■11 IRMMcn. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1NSRR TYPE OF INSURANCE AODL SUER POLICY NUMBER MM IC POLICY EXP INSO YYYO ( ) (MMIGOITYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS- F OCCUR _ _ OAMAZiE TOREN'fl_D PREMISES (Ea occe7rencel $ MEA EXP (Any. one poria) $ PERSONAL S ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGI4E GATE S [JOC —OLICY�'RO- IFCT PRODIICPS _(XC)MPIOPA68 S T -ER $ AUTOMOBILE LIABILITY DMIT$ -- — fEaBcddenU - ANY AUTO BODILY INJURY (Por person) $ OWNED SCHEDULED AUTOS ONLY _ AUTOS 1300ILYINJURY Paracctdl1r11 i I S HIRED NON -OWNED _ f+ROPER71'-[7l4MAGE AUTOSONLY AUTOS ONLY .1Pi[.QOddCAU $ UMBRELLA LIAR I OCCUR EACH OCCURRENCE $ EXCESS LIAR !II CLAIMS -MADE AGGREGATE S EO RETENTf g WORKERSMP N TI N�/ A AND EMPLOYERS' LIABILITY YIN X STATUTE __ ER 4NYPROPRIETORIPARTNERIEX �DFFICFWMEMBER EXCLUDFD7 E L. EACH ACCIDENT i 1,OOD,�00 (Mandatory In NH) If yos, describe under NIA 051378325 10/01/2022 10101/2023 E.L DISEASE - EA EMPLOYEE �, 1,000,000 DESCRIPTION OF OPERATIONS bolow EL DISEASE- POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space Is required) WAIVER OF SUBROGATION IN FAVOR OF CERTIFICATE HOLDER WHEN REQUIRED BY WRITTEN CONTRACT. RE: 7042 LANPHIER HIGH SCHOOL -ADDITIONS L RENOVATIONS -1300 N. 117H ST., SPRINGFIELD, IL 62702 RE: 7042 LANPHIER HIGH SCHOOL.ADDITIONS L RENOVATIONS -1300 N. 11TH ST, SPRINGFIELD, IL 62702 Green De-11don Contract— Inc (2466) le Included as o nomad Insured through endoreamenl. Workan Compensellen coaaregs Is provided to—playsse leased to Green Demolltlen Contnctora Inc through Rasoureing Edge 1, LLC SAMPLE HAROLD O'SHEA BUILDERS, INC. GENERAL CONTRACTOR 3401 CONSTITUTION DR. SPRINGFIELD, IL 62711 1 IUIN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE ®1988-2016 ACORD CORPORATION. All riahtn raservnrl ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number GREEN DEMOLITION CONTRACTORS INC. 4840 S ST LOUIS AVE SUITE 100 Policy Number CHICAGO, IL 60632 Symbol: WLR Number: C51378325 Policy Period Effective Date of Endorsement 10/01/2022 TO 10/01/2023 10-01-2022 Issued By (Name of Insurance Company) Indemnity Insurance Co. of North America Insert the policy number. The remainder of tho informalion is to be complaled only when Ibis endorsement is Issued subsequent to the prop aratmn of tha policy. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule ANY PERSON OR ORGANIZATION AGAINST MOM YOU HAVE. AGREED TO WATVR YOUR R1C11T Or' RhICOVERY 1N A WRi T^_EN CONTRACT, PROVIDL:U SUCH CONTRACT WAS EXECUTED PRIOR TO 'I'HE DATE OF I OSS. For the states of CA, UT, TX, refer to state specific endorsements. This endorsement is not applicable in KY, NH, and NJ. The endorsement does not apply to policies in Missouri where the employer is in the construction group of code classifications. According to Section 287.150(6) of the Missouri statutes, a contractual provision purporting to waive subrogation rights against public policy and void where one party to the contract is an employer in the construction group of code classifications. For Kansas, use of this endorsement is limited by the Kansas Fairness in Private Construction Contract Act(K.S.A.. 16-1801 through 16-1807 and any amendments thereto) and the Kansas Fairness in Public Construction Contract Act(K.S.A 16-1901 through 16-1908 and any amendments thereto). According to the Acts a provision in a contract for private or public construction purporting to waive subrogation rights for losses or claims covered or paid by liability or workers compensation insurance shall be against public policy and shall be void and unenforceable except that, subject to the Acts, a contract may require waiver of subrogation for losses or claims paid by a consolidated or wrap-up insurance program. Authorized Representative WC 00 03 13 (11/05) Copyright 1983-2017, National Council on Compensation Insurance, Inc. All Rights Reserved SAMPLE ATE (MMIDDIYYYY) Rte'° CERTIFICATE OF LIABILITY INSURANCE U10/05/2022 1U/OS/2022 PRODUCER THIS CERTfFICATE IS ISSUED AS MATTER OF INFORMATION Mark Mackey Ins Agcy ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 3338 W Coster HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Chicago, IL 60625 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Li•••��• •J INSURERS AFFORDING COVERAGE NAIC # INSURED GREEN DEMOLITION CONTRACTORS INC INSURER A: State Farm Mutual Auto Insurance Camparly Company25178 INSURER B: 1 CLAIMS MADE ] OCCUR 4850 South St. Louis Avenue INSURERC: Suite 100 Chicago, Il 60632 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BFFN RFDUCED BY PAID CLAIMS - LAIMS.INSR it inaAOD'L POLICYEFFECTIVE POLICYEXPIRATION LTR IINORDI TYPE OF INSURANCE POLICY NUMBER DATE MMIDD DATE MMIDD LIMITS GENERAL LIABILITY _C_OMM411CIAL GENERAL LIABILITY EACH OCCURRENCE D/UG OE TD REFIT p.!�E9-1 SFALEIU MED EXP (Any onRpMgr0,_ 1 CLAIMS MADE ] OCCUR PERSONAL B ADV INJU Y GENERAL AGGREGATE GENLAGGREGATEUMrrAPPU(ESPER PR PRODUCTS -COMPIOPAGG S POLICY I LOC A X AUTO MOBILE LIABILITY X ANY AUTO E615564 -B28-13 AUG -31-2.2 AUG -31-23 COMBINED SINGLE LIMIT (Ea accident) $ 5,000, 000 X_ ALL OWNED AUTOS X SCHEDULED AUTOS BODILY INJURY (Per person) $ X HIRED AUTOS X NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY A 7 l -F OTHER THAN EA ACC S ANY AUTO AUTO ONLY: AGI; S EXCESSAIMSRELLA LIABILITY EACH OCCURRENCE $ AG TE OCCUR Lij CLAIMS MADE DEDUCTIBLE 3 fi TENTION i WORKERS COMPENSATION AND EMPLOYERS'LIABILITY WC STATU- OTH- TORY LIMIT ER _� ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? E L EACH ACCIDENT _E If yes, describe under - L DISEASE - FA F1vIPLDY S SPECIAL PROVISIONS bBlow EL DISEASE - POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS I LOCATIONS) VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS RE:7042 Lanphier High School -Additions and Renovations -1300 N 11th St, Springfield, 1L 62702 Additional Insured with respect to General Liability and Hired & Non Owned Auto Liability(Umbrella follow form) on a Primary & Non -Contributory basis when required by written contract per TSO Forms CG 2010 10/01 and CG 2037 10/01 for work performed by Green Demolition Contractors, Inc. A Waiver of. Subrogation in favor of Additional Insureds with respect to General Liability an Hired & Non Owned Auto Liability(Umbrella follows form) when required by written contract is included per ISO form CG 2404(05/09) Harold O'$hea Builders, Inc C). Lp"]Z,�eW Public School District 186(Owner); and BLDD(Archi.tect) urm I smCA I E HOLDER ms /A J xn 1-' 1 - H_ CANCELLATION HAROLD O'SHEA BUILDER'S INC GENERAL CONTRACTOR 3401 CONSTITUTION DR SPRINGFLELD IL 62711 rhe registration notices indicate ownership SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 90 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. the marks by their respeclive owners @ACORD CORPORATION 1988, 2007 All rights roserved SAMPLE ACORD 25 (2001108) AUTHORIZED REPRESENTATIVE MARK MACKEY IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or after the coverage afforded by the policies listed thereon. SAMPLE ACORD 25 (2001/08) CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK RESPONSIBLE BIDDER CHECKLIST Project Name Martin Luther King Jr. Center Demolition Project Project No. Project 121-066 For Bids Due December 13, 2022 Contractor Name: Green Demolition Contractors Incorporated The City seeks to enhance its ability to identify responsive and responsible bidders on all City public works projects by institution of comprehensive submission requirements in compliance with State law. Quality workmanship, efficient operation, safety, and timely completion of projects requires that all bidders meet certain minimum requirements to be responsive and responsible bidders. THIS FORM MUST BE SUBMITTED WITH YOUR BID. INSTRUCTIONS: If you are a pre -qualified bidder, complete Section I only. If you are not a pre -qualified bidder, complete Section II only. Section II acts as an application for pre -qualification. Submission of Section II will allow the bidder to be considered for pre -qualification for bids with the City of South Bend Department of Public Works. Pre- qualified bidders will then be exempt from a portion of the submission requirements outlined in Section 6- 63 of The Responsible Bidding Ordinance No. 10594-18 (hereinafter, "Responsible Bidding Ordinance") for a period of twelve (12) months. Thereafter, contractors who are pre -qualified must submit a complete application for continuation of "pre- qualified" standing, on a form provided by the City ("Responsible Bidder Checklist (1) Pre -Qualified Bidders") by December 31 s� 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. CITY OF SOUTH BEND JAMES MUELLER, MAYOR DEPARTMENT OF PUBLIC WORKS ERIC HORVATH, DIRECTOR June 17, 2021 Ms. Laura Hayes Green Demolition Contractors, Inc. latracreettdennolitioninc.com RE: Pre -Qualification Verification — 905-907-909 Michigan Demolition — Project No. 120- 063R Dear Ms. Hayes: This letter serves as verification of Pre -Qualification status of your company for bidding with the City of South Bend. This Pre -Qualification status is effective for twelve (12) months from the date of this letter. Thereafter you are required to re -submit a complete application for continuation of pre -qualification status prior to December 31 for the upcoming calendar year. A copy of this Verification Letter must be included with every bid exceeding $150,000 submitted to the City of South Bend Board of Public Works, along with your Pre -Qualified Bidder Checklist and attachments. If you have any further questions regarding this matter, please call this office at (574) 235-9251. Sincerely, Digitally signed by Liz.—all Liz HorvathR44 bwle h@f Lhbendhgo Dale: 1021.061] 12:45:19-04'00' Liz Horvath, Permit Manager 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. 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. (ii) _ By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided by me, and may also conduct random inquiries of my current and prior customers. (b) Attachments: (i) x Indiana Secretary of State's on-line records (ie. Business verification) dated within sixty (60) days of the submission of said document showing that business is in existence, current with the Indiana Secretary of State's Business Entity Report, and eligible for a certificate of good standing. (Not applicable to individuals, sole proprietors or partnerships). (ii) x Statement on staffing capabilities, including labor sources. This statement indicates and ensures I have sufficient employees on staff to complete the work. It outlines how I intend to meet the staffing needs of the work. (iii) x Evidence that I am utilizing a surety company which is on the United States Department of Treasury's Listing of Approved Sureties as required in the bid specifications or contract. (iv) x List of projects of similar size and scope of work performed in all areas, including the State of Indiana, within the last three (3) years. 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) x 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) x 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 anytime and shall be furnished x 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) x Indiana Secretary of State's on-line records (ie. Business verification) dated within sixty (60) days of the submission of said document showing that business is in existence, current with the Indiana Secretary of State's Business Entity Report, and eligible for a certificate of good standing. (Not applicable to individuals, sole proprietors or partnerships). (ii) x List identifying all former business names. (iii) X 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) x 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) x 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) x 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 x 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 x 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. (ix) x 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) x 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. December 13, 22 Date Michael J. Brough, President (Print Name Here) Green Demolition Contractors, Incorporated (Name of Company) 523 Northbrook Drive (Address of Company) Michigan City (City) Indiana 46360 (State) 312-409-4771 (Telephone Number) Business [?stalls - • - - --� - Business Name: GREEN DEMOLITION CONTRACTORS INCORPORATED Entity Type: Domestic Limited Liability Company Creation Date: 06/11/2015 Principal Office Address; 523 NORTHBROOK DRIVE, MICHIGAN CITY, IN, 46360, USA Jurisdiction of Formation: Indiana Governing Person information BUSINESS INFORMATION HOLLI SULLIVAN INDIANA SECRETARY OF STATE 12/12/2022 05:58 PM Business ID: 2015061100177 Business Status: Active Inactive Date: Expiration Date: Perpetual Business Entity Report Due 06/30/2023 Date: Years Due: Title Name Address President Michael Brough 523 Northbrook Drive, Mich City, IN, 46360, USA Registered Agent Informatic►zt � ____ —_ T - __ . _ --. • _ � _ __ -- Type: Individual Name: MICHAEL BROUGH Address: 523 NORTHBROOK DRIVE, MICHIGAN CITY, IN, 46360, USA CIHNCINNATI INSURANCE COMPANIES December 2022 The Cincinnati Insurance Company ■ The Cincinnati Indemnity Company The Cincinnati Casualty Company ■ The Cincinnati Specialty Underwriters Insurance Company The Cincinnati Life Insurance Company RE: Green Demolition Contractors Inc. — Bonding Capacity To Whom It May Concern: The Cincinnati Insurance Company (AM Best Rating of A+XV) provides surety bonding credit to Green Demolition Contractors Inc. They are one of our finest accounts and we highly recommend them. We currently have $5,000,000 single job/$10,000,000 aggregate bond program available for this firm. Should a situation merit, we would consider requests beyond these parameters as well. Any specific request for bonds will be underwritten on its own merits and any arrangement for bonds required by any contract is a matter between Green Demolition Contractors Inc.and the surety and we assume no liability to you or your third parties, if for any reason we do not execute these bonds. Feel free to contact us with any questions you may have. Sincerely, Natalie Koster Attorney -in -Fact Field Director Surety Natalie—Koster@cinfin.com Mailing Address:P.O. Box 145496 • Cincinnati, Ohio 45250-5496eHeadquarters: 6200 S. Gilmore Road • Fairfield, Ohio 45014-5141 cinfin.corrr 513-870-2000 REVIEW REPORT FOR THE YEAR ENDED DECEMBER 31, 2021 Sabena Fax Accounting for your future Green Demolition Contractors, Inc. Review Report For the Year Ended December 31, 2021 Table of Contents Independent Accountant's Review Report Financial Statements: Balance Sheet 2 Statement of Income 3 Statement of Stockholder's Equity 4 Statement of Cash Flows 5 Notes to the Financial Statements 6-16 Supplementary Information: Independent Accountant's Review Report on Supplementary Information 17 Schedule of Cost of Contract Revenues Earned 18 Schedule of Operating Expenses 19 SelcleYl Fox-. Accounting for your future 6'19nieipnse Dwe Oak Book, Illinois 60523 4�,w,1w.seld�ni0x.com ID 630 954,1400 f 630.954 1327 e maiLaselnienfox.com INDEPENDENT ACCOUNTANT'S REVIEW REPORT Mr. Michael Brough Green Demolition Contractors, Inc. Chicago, Illinois We have reviewed the accompanying financial statements of Green Demolition Contractors, Inc., which comprise the balance sheet as of December, 31, 2021, and the related statements of income, stockholder's equity and cash flows for the year then ended, and the related notes to the financial statements. A review includes primarily applying analytical procedures to management's financial data and making inquiries of company management. A review is substantially less in scope than an audit, the objective of which is the expression of an opinion regarding the financial statements as a whole. Accordingly, we do not express such an opinion. Management's Responsibility for the Financial Statements Management is responsible for the preparation and fair presentation of these consolidated financial statements in accordance with accounting principles generally accepted in the United States of America; this includes the design, implementation, and maintenance of internal control relevant to the preparation and fair presentation of consolidated financial statements that are free from material misstatement whether due to fraud or error. Accountant's Responsibility Our responsibility is to conduct the review engagement in accordance with Statements on Standards for Accounting and Review Services promulgated by the Accounting and Review Services Committee of the AICPA. Those standards require us to perform procedures to obtain limited assurance as a basis of reporting whether we are aware of any material modifications that should be made to the financial statements for them to be in accordance with accounting principles generally accepted in the United States of America. We believe that the results of our procedures provide a reasonable basis for our conclusion. We are required to be independent of Green Demolition Contractors, Inc. and to meet our other ethical responsibilities, in accordance with the relevant ethical requirements related to our review. Accountant's Conclusion Based on our review, we are not aware of any material modifications that should be made to the accompanying financial statements in order for them to be in accordance with accounting principles generally accepted in the United States of America. sgoko J4, Ak. November 17, 2022 mgiwoi ldwide Green Demolition Contractors, Inc. Notes to the Financial Statements 1. Nature of Operations Green Demolition Contractors, Inc. (Company) is a demolition contractor engaged in the deconstruction of industrial, commercial, municipal and privately -owned buildings primarily in the greater Chicagoland area. The work is generally performed under fixed price contracts. The length of contracts varies and generally does not extend beyond one year. The Company commenced operations on July 30, 2007. 2. Summary of Significant Accounting Policies Use of Estimates — Management uses estimates and assumptions in preparing these financial statements in accordance with accounting principles generally accepted in the United States of America (GAAP). Those estimates and assumptions affect the reported amounts of assets and liabilities, the disclosure of contingent assets and liabilities, and the reported revenues and expenses. Actual results could vary from the estimates that were used. Significant estimates used in the preparation of these financial statements include the following: The Company has estimated an allowance for doubtful accounts of $140,000 at December 31, 2021. This conclusion is based on the status and age of contracts receivable. The Company has many contracts in various stages of completion. The Company must make estimates of the extent and progress towards completion, contract revenue and contracting costs, and it uses the cost to cost method of accounting for all of its long-term contracts. For the above mentioned estimates, it is reasonably possible that the recorded amounts could significantly change in the near future, as new information is available. Revenue Recognition — Demolition work is a single performance obligation that is satisfied over time. The Company recognizes contract revenue for financial reporting purposes over time. Progress toward completion of the Company's contracts is measured by the percentage of cost incurred to date to estimated total costs for each contract. The Company tracks demolition work by customer industry. The approximate percentages of customer revenues to total demolition revenue was school districts 17%, commercial businesses 5%, governments 43%, and healthcare 35%. As part of the Company's demolition work, the Company also salvages certain material to sell for an additional revenue stream. This revenue is recognized at a certain point in time upon sale. Total scrap revenue represents approximately 18% of total revenue. Green Demolition Contractors, Inc. Notes to the Financial Statements (cont'd) 2. Summary of Significant Accounting Policies (cont'd) Revenue Recognition (cont'd) This method is used because management considers total cost to be the best available measure of progress on contracts. Because of inherent uncertainties in estimating costs, it is at least reasonably possible that the estimates used will change significantly within the near term. Contracts are fixed price. The payment terms and conditions in customer contracts vary. Payment typically is due over time in installments, based on project phases as specified in the contracts. Final payment is due when all performance obligations identified in the contract are completed. Cost Recognition — Contract costs include all direct material, subcontractor and labor costs and those material indirect costs related to contract performance. Provisions for estimated losses, if any, on uncompleted contracts are made in the period in which such losses are determined. Changes in job performance, job conditions, and estimated profitability, including those arising from contract penalty provisions, and final contract settlements may result in revisions to costs and income and are recognized in the period in which the revisions are determined. Mobilization costs incurred that include the initial costs to move equipment, personnel and supplies to a job site are insignificant. The contract asset represents revenues recognized in excess of amounts paid or payable (contract receivables). The contract liability represents the Company's obligation to perform on completed contracts with customers for which the Company has received payment or for which contract receivables are outstanding. Contract Receivables — Contract receivables from performing construction projects are carried at their estimated collectible amounts. When payment of the retainage is contingent upon the Company fulfilling its obligations under the contract it does not meet the criteria to be included in contracts receivable and remains in the contract's respective contract asset or contract liability, determined on a contract -by -contract basis. Retainage for which the Company has an unconditional right to payment that is only subject to the passage of time are included in contracts receivable. The Company provides an allowance for doubtful collections which is based upon a review of outstanding receivables, historical collection information, and existing economic conditions. Payments on invoices are due 30 days after the issuance of the invoice. Contract retentions are due 30 days after completion of the project and acceptance by the owner. Delinquent receivables are written off based on individual credit evaluations and specific circumstances of the customer. At December 31, 2021, the Company considered $140,000 of contract receivables to be uncollectible and is recognized as an allowance for doubtful accounts. Property and Equipment — Property and equipment are recorded at cost less accumulated depreciation. Assets are depreciated over their estimated useful lives that range between five and seven years. Costs of maintenance and repairs are charged to expense when incurred. -7- Green Demolition Contractors, Inc. Notes to the Financial Statements (cont'd) 2. Summary of Significant Accounting Policies (cont'd) Paycheck Protection Program Revenue — The Company accounts for Paycheck Protection Program loan proceeds as a grant under Accounting Standards Codification (ASC) Subtopic 958-605, which allows for revenue to be recognized when conditions surrounding the cancellation of a liability, such as a forgivable loan have been substantially met or have been explicitly waived by the resource provider. In March 2021, the Company received $653,764 of proceeds in the form of a potentially forgivable loan under the Paycheck Protection Program (PPP) under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). ' Under the terms of the PPP, as subsequently modified by the Paycheck Program Flexibility Act (PPPFA), principal and interest payments are deferred until a forgiveness determination is made and any amounts not forgiven can be repaid over two years at an annual interest rate of 1%. Conditions of forgiveness include incurring qualified expenditures within an 8 -week or maximum 24 -week timeframe beginning with the date the loan proceeds are received, maintaining payroll levels on an employee -by -employee basis, and maintaining headcount, within PPP parameters. The Company believes they incurred $653,764 of qualified expenditures over a 24 -week period and that the conditions relating to maintaining payroll levels were substantially met as of December 31, 2021. As such, the Company has recognized the related forgiveness as Paycheck Protection Program revenue in the accompanying financial statements. Subsequent to year end, in March 2022, the Company received formal notification that their application for forgiveness had been approved by the United States Small Business Administration. The application for loan forgiveness is subject to audit by the Internal Revenue Service. Any disallowed credits as a result of an audit would become a liability to the Company. Variable Interest Entities — The Company does not to evaluate qualifying entities, who are under common control, under FASB Accounting Standards Update (ASU) 2018-17, Consolidation (Topic 810). Targeted Improvements to Related Party Guidance for Variable Interest Entities, which provides private companies with an accounting alternative for certain commonly controlled entities. Income Taxes — The Company with consent of its stockholder elected to be taxed under the Internal Revenue Service as an S Corporation. In lieu of corporate income taxes, the stockholders of an S corporation are taxed on their proportionate share of the Company's taxable income or loss. Therefore, no provision or liability for current federal income taxes has been included in the financial statements. The Company will be subject to Illinois replacement tax at a rate of 1.5% of net taxable income. 11110 GREEN DEMOLITION CONTRACTORS, INC. 523 Northbrook Drive Incorporated in the .urate o, f Illinois in tlae Year 2007 References with Contract Amounts Northern Indiana Commuter Transportation District (NICTD) 333 East US Highway 1.2 Chesterton, Indiana Mr. Jeff Decker 219-926-5744 Double Track Northwest Indiana Naject Contract 1 Double Track Northwest Indiana Project Contract 2 Michigan City, IN 46360 312-4109-4771 office $1, 709, 7120 00 $ 898,165 00 Wreck and Remove Various Residential and Commercial Properties Backfill and Restore Site. Tonn & Blank Construction 1623 Greenwood Avenue Michigan City, IN 46360 219-878-6289 Mr. Curt Cipares Felinciscan lre�altla b'lrasvlatral lidirhig&n City $ 2,145,74.. 00 Wreck and Removal of an Existing Six Story 500,000 square feet Operational Hospital Building Including Tower. Self perform on site Concrete Crushing/Recycling, Reduced and Repurposed to be used as Suitable Compacted Backfill Material for site. Manage front end of demolition project i.e. coordination of all utility disconnects, Environmental Remediation, etc. Perform all HSMS removals. Dismantle existing 8 story building from portion of operational hospital to remain. Wreck and remove approx 300,000 sf of remaining building. 90% of Demolition debris recycled throughout the process all remaining debris hauled off site. Backfill and restore site. Vision Construction & Consulting 1733 N. 33rd Stone Park, Illinois 60165 Mr. Mark Weiner 708-488-1.926 J Morton Slerting ,HYD 201 High School Knowledge Center $ 3,570,755.00 � P 18,baday Fat : � °z [ ryq - ..V,,s GP,EE DEMOLITION CONTRACTORS, INC. 523 Northbrook Drive Michigan City, IN 46360 312-409-4771 office Interior Selective and Exterior Wreck Removals of an Existing High School Building Perform interior demolition throughout the entire Nigh School. 'Work was performed during off hours weekends, holidays and summer vacation and at times during normal school day while students were present. GDC performed extensive Structural Demolition and Shoring on an as needed basis as this school was 130 years old with unforseens. Demolition of 10.3 Abandoned Properties $16099090.00 Scope of 'Fork. Wreck and Remove Complete with Grading and Seeding of 103 properties Might Co. 2500 Frontage Road Darien, Illinois 60156 630-969-7000 Downers Grove SD 99 Architectural Renovations Architectural/Structural Removals of Auditorium $10969964 00 Perform heavy Structural Demolition for the removal of an Existing Auditorium that was built into the school bldg on three elevations. Extensive dismantling and shoring took place to ensure the school and children were not affected throughout the course of the school day. performed selective and Structural Demolition throughout the school. Brown & lWomen, Inc. 823 E. Drexel Square Chicago, IL 60615 Mr. David Clark 312-788-0770 Marshall Field Garden Apartments Building S $114 4, 000.00 Scope of Work: Interior selective removals of all finishes multi story level HUD Building s�b�dcBgz2&' Es'<A. LChii ac �� eX&L"i' Osman Construction 70 West Seegers Load Arlington Heights, Illinois 60005 547-593-2705 Mr. Tian Silvetti Rodeway Inn Hotel Skokie Illinois GREEN DEMOLITION CONTRACTORS, INC. 523 Northbrook Drive Michigan City, IN 46360 312-409-4771 office S 863,425.00 Complete Wreck and Removal of 4 Story Motel, Pool, Restaurant, Parking Deck, Including Site Restoration Wreck Removal Portion of School Building Selective Interior Demolition Cook County Land Bank Authority 69 We Washington Suite 2935 Chicago, IL 60602 Mr. Mustafaa Saleh 312-603-5015 Scope of Work - 5 719,, 75.00 92.i!, 000.00 ®,pen Ended Contract ongoing through the depletion of Grants/Funds Demolition of Abandoned / Vacant Homes throughout Chicago and Cook County. City of ChicagolWight Co. 2500 North Frontage Road Darien, IL 60561 Dennis Podzimek 630-915-9425 City Hall Space C'onsolidati oul Ma-vor's Floor Scope of Work; $ 1,498,900.00 Multiple Interior Floor Selective Removals of 100,000 s.f Finishes and Furnishings. Working in strict adherence with Municipal Building — Security Procedures 00d -ay FG'r"' Rockford Construction Grand Rapids, M149508 Brod Burgess 616-437-4226 LaPorte, In Meer Store Scope of Work. - GREEN DEMOLITION CONTRACTORS, TORS, INC. 523 Northbrook Drive Michigan City, IN 46360 312-409-4771 office 3 787,000.00 Corimplete 100% gut re -habilitation project with Bobcat machines of an existing Big Box facility consisting of ceilings, drywall partition walls, storefronts, facades, floorings, concrete removals, M.E.P. and portion of structure removals. Tonn & Blank Construction LLC 1623 Greenwood Ave. Michigan City, 1N 46360 Noel Gonzales 219 877-8174 frutoivia Ar dst Lots S 611,086 00 Michigan City, IN Scope of Work. Interior Selective Finish / Abatement and Structural Removals of Multi Level Facility Barton Malow Company 150 N Upper Wacker Dr 41650 Chicago, IL 60606 Brian Courtney 312-281-0821 Argonne National Laboratory $ 212, 000.00 Argonne National Lab — Materials Engineering Building 370 Building 360 Ekponsion Scope of Work; Green Demolition performed wreck removals within Building 370 adjacent to an ongoing Phosphorous Experiment working in direct Conjunction with electric, communications systems, sprinkler systems, natural gas and steam while performing lead and asbestos abatement. Green Demolition performed a Building Wreck within 10 feet of a Linear Accelerator without service interruptions to the electric, water, sewer, natural gas, steam and communications systems. GREEN DEMOLITION CONTRACTORS INCORPORATED 523 Northbrook Drive Michigan City, IN 46360 312-409-4771 Main December 13, 2022 City of South Bend Department of Public Works 227 Jefferson Boulevard South Bend, Indiana 46601 Re: Prequalification Responsible Bidder Green Demolition Contractors Incorporated has no former business names. Respectfully submitted, Michael Brough, President Green Demolition Contractors, Inc. "Recycling Today For A Greener Tomorrow"' GREEN DEMOLITION CONTRACTORS INCORPORATED 523 Northbrook Drive Michigan City, IN 46360 312-409-4771 Main December 13, 2022 City of South Bend Indiana Board of Public Works 1316 City County Building 227 West Jefferson Boulevard South Bend, Indiana 46601 Re: Prequalification Violations/Determinations Green Demolition Contractors Incorporated has had no 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. Respectfully submitted, Michael Brough, President Green Demolition Contractors, Inc. "Recycling Today For A Greener Tomorrow" GREEN DEMOLITION CONTRACTORS INCORPORATED 523 Northbrook Drive Michigan City, IN 46360 312-409-4771 Main December 13, 2022 City of South Bend Department of Public Works 227 Jefferson Boulevard South Bend, Indiana 46601 Re: Prequalification Green Demolition Contractors has never had any contract of any kind cancelled for non- performance. Thank you, Michael Brough, President Green Demolition Contractors Inc. "Recycling Today For A Greener Tomorrow" GREEN DEMOLITION CONTRACTORS, INC. 523 Northbrook Drive Michigan City, IN 46360 312-409-4771 main Qty Description EQUIPMENT LIST 2 Link Belt 145 Excavators 2 Link Belt 350 Excavators 1 Cat 963 Track Loader 2 Cat 950 End Loaders 1 Cat D-5 Dozer 2 330 Excavators Caterpillar 2 320 Excavators Caterpillar 2 Mini Excavators 28 Skidsteer Bobcats 8 Excavator Hammers 8 Excavator Grapples 8 Overseas Containers Converted for Roll Off Trucks 4 65 Yard Roll Off Boxes 4 40 Yard Roll Off Boxes 8 30 Yard Roll Off Boxes 6 20 Yard Roll Off Boxes 1 Flat Deck for Roll Off w/ Built In Wench 1 20 Ton Flat Deck Trailer 1 10 Ton Flat Deck Trailer 1 Bobcat Tag Trailer 1 Tilt Deck Trailer 1 Flat Deck Single Axel 1 Ingersoll Rand Mason Lull 2 Lull Conversion Brackets 1 350 Excavator Wrecking Pole 8 Wrecking Poles 2 2018 Kenilworth Tractor Trailers 2 2020 Ford One Ton Dually Dump Trucks 2 2005 Mack Tractors 2 2006 Mack Six Wheeler Roll Off Trucks Bobcat Hammers, buckets and various attachments for Excavators and Bobcats 1 Low Boy Trailer 2 2011 Galbreath Semi Roll Off Trailers 2 Terminators 3 Atlas Capco 185 Air Compressors 2 Ingersoll Rand 250 Air Compressors 10 Cargo Trailers 2 Water Trailers Misc Hand Tools, Boxes, Equip i.e. Saw, Air Hammers, etc Equipment and tools listed above are free of encumbrances, none of the above listed items are leased, all equipment is owned by Michael Brough, President Green Demolition Contractors, Inc. Michael Brough, President "Recycling Today For A Greener Tomorrow" GREEN DEMOLITION CONTRACTORS INCORPORATED 523 Northbrook Drive Michigan City, IN 46360 312-409-4771 Main December 13, 2022 City of South Bend Department of Public Works 227 Jefferson Boulevard South Bend, Indiana 46601 Re: Competent Persons On Site Green Demolition Contractors Incorporated is Signatory to the International Laborers Union as well as Local 150 Midwest Operating Engineers. Our Field Foreman / Employees and General Superintendent are fully trained Journeyman with combined Field Experience of over 90 years Respectfully submitted, Michael Brough, President Green Demolition Contractors, Inc. "Recycling Today For A Greener Tomorrow" GREEN DEMOLITION CONTRACTORS INCORPORATED 523 Northbrook Drive Michigan City, IN 46360 312-409-4771 Main December 13, 2022 City of South Bend Department of Public Works 227 Jefferson Boulevard South Bend, Indiana 46601 Re: Tax Lien Statement Green Demolition Contractors has no outstanding Tax Liens Federal - State nor Local and has had none since its inception/incorporation. Respectfully submitted, Michael Brough, President Green Demolition Contractors, Inc. "Recycling Today For A Greener Tomorrow" ACVRd CERTIFICATE OF LIABILITY INSURANCEI DATE(MMIDD/YYYY) 10/1012022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME David S. Parrilli Parrilli, David PHONE(312) 621-5182 FAX AfX NO(312) 621-2288 (WrThe Rockwood Company E-MAIL dparrilli(a)rockwoodce com ADDRESS: 20 N Wacker Drive, Suite 600 INSURER(S) AFFORDING COVERAGE NAIC M Chicago IL 60606 INSURER A : Navigators Specialty Ins Co. 36056 INSURED INSURER 13: Slarstone National Insurance Co. 25496 Green Demolition Contractors, Inc INSURER C: Hallmark Specialty Insurance Co. 26808 4840 S Sl Louis Ave Ste 100 INSURER 0: INSURER E: Chicago IL 60632 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMRFR: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L7 TYPE OF INSURANCE ilNli�+ yry� POLICY NUMBER [Y EFF MMIDDlYYYYI- POLICY EXP (MMI00!►'YYY] LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCURFL EACH OCCURRENCE $ 1,000,000 DAMAGE �� rr 50,000 P I REMISES IE dccunenpa 8 u MED EXP (Any one person] $ 5,000 A X X CE22CGL1326961C 10/01/2022 10/01/2023 PERSONAL a ADV INJURY S 1,000,000 GE111L AGGREDATE LIMIT APPLIES PER: AOLICY © PRO- ❑ LOC2,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ $ OTHER AUTOMOBILE LIABILITY CONGLE LIMIT $ 1,000,000 A0=1 BODILY INJURY (Per person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS X X CE22CGL1326961C 10101/2022 10/01/2023 BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPER lYAM E vnr don $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 B EXCESS LIAB CLAIMS -MADE 59095822AALI 10/01/2022 10/01/2023 AGGREGATE $ 5,000,000 DEP I X1 RETENTION 1 10.0()0 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN N R OTrt- STATUTE FR EL EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? NIA E.L DISEASE - EA EMPLOYEE S (Mandatory In NHI If yes, describe under E.L DISEASE-PQLICYLMT $ DESCRIPTION OF OPERATIONS below C Excess Umbrella Liability 79EX-000708922-00 10/0112022 10/01/2023 Each Occurrence 5,000,000 Aggregate 5,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: 7042 Lanphier High School - Additions and Renovations - 1300 N 11 th St, Springfield, IL 62702 Additional insureds with respect to General Liability and Hired & Non Owned Auto Liability (Umbrella follows form) on a Primary & Non Contributory basis when required by written contract per ISO Forms CG 2010 10/01 and CG 2037 10/01 (attached) for work performed by Green Demolition Contractors, Inc. A Waiver of Subrogation in favor of Additional Insureds with respect to General Liability and Hired & Non Owned Auto Liability (Umbrella follows form) when required by written contract is included per ISO farm CG 2404 (05109): Harold O'Shea Builders, Inc (GC), Springfield Public School District 186 (Owner); and BLDD (Architect) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Harold O'Shea Builders, Inc ACCORDANCE WITH THE POLICY PROVISIONS. General Contractor 3401 Constitution Drive AUTHORIZED REPRESENTATIVE Springfield IL 62711 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CE22CGL1326961C COMMERCIAL GENERAL LIABILITY CG 20 10 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person or organization for whom you are performing operations during the policy period have agreed in writing in a contract or agreement be added as an additional insured on your policy (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II - Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to "bodily in- jury" or "property damage" occurring after: SAMPLE (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the addi- tional insured(s) at the site of the cov- ered operations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another con- tractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 10 01 © ISO Properties, Inc., 2000 Page 1 of 1 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: CE22CGL1326961C CG 20 3710 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person or organization for whom you are performing operations during the policy period have agreed in writing in a contract or agreement be added as an additional insured on your policy Location And Description of Completed Operations: Additional Premium: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II - Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" at the location designated and described in the schedule of this endorsement performed for that insured and included in the "products -completed operations hazard". SAMPLE CG 20 37 10 01 © ISO Properties, Inc., 2000 Page 1 of 1 POLICY NUMBER: CE22CGL1326961C COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER. OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any person or organization for whom you are performing operations during the policy period have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph S. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. SAMPLE CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 DATE (MMIDDIYYYY) AC `C]K� 0912712022 k�- CERTIFICATE OF LIABILITY INSU"NCE Acct#: 2494005 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT LOCKTON COMPANIES, LLC NAME] PHONE 2100 ROSS AVE., SUITE 1400 (".Ko,E.n: 214-7711-4411 WC. NO DALLAS, TX 75201 E-KMLAOURESS: W CORE SOU RCIN GEDO E.COM INSURED GREEN DEMOLITION CONTRACTORS INC. 4840 S ST LOUIS AVE SUITE 100 CHICAGO, IL 60632 INSURERI B} AFFORDING COVERAGE 1 4311RER A: IRdem Illy Intl U ranee CO. Of Norlh Amo rice INSURER a. INSURER C INSUR ER O : INSURERE. NAIL C 43575 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADOL 66it POLICY EFF POLICY EXP LTR— TYPE OF INSURANCE INGO VVvD POLICY NUMBER (MMIDDrt/YYY (MMIDD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS- OCCUR ,j� DAMAGE T`4ItEftlTED PREMISES (Ea ocrurtoecel $ I� J MED EXPIAny ono person) $ ij PERSONAL d ADV INJURY $ G_EN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ �p5R0- DOC I {{�DLICY L.-1 PRODUCTS - COMP/OP AGO S ]6iH[it I 1111I I $ AUTOMOBILE LIABILITY COMBINED o $ (Ea aueidenl) ANY AUTO BODILY INJURY (Por person) T OWNED l SCHEDULED AUTOS ONLY AUTOS. EMILY INJURY (aor 8CCldonq 5 HIRED NOR -OWNED "PROPERTY DUNNAGE AUTOS ONLY AUTOS ONLY I LM mCNd"D $ — _ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE $ EDETENiI N W M N All ON_ A AND EMPLOYERS' LIABILITY YIN X STATUTE _ ERH _ 4NYPROPRIETORIPARTNERIEXECUTIVE DFFICEWMEMBER EXCLUDED? NIA 051370325 1010112022 10101/2023 EL EACH ACCIDENT $ 1,000,000 (Mandatory In NH) If yos, describe under DESCRIPTION OF OPERATIONS below EL DISEASE - EAEMPLOYEE $ 1?BDD t 000 —. .. _._._ .__. EL DISEASE- POLICY LIMIT $ 1,000,000 I OESCRIPYMN OF OPE RATIONS LOCA DONS I VEHICLES (ACORD Q1. Addillortal Rem ann 30%dVle, mey h6 all settnd If mora apace Is mqul red) WAIVER OF SUBROGATION IN FAVOR OF CERTIRCATO HOLDER WHEN AEQUI RED UY WRITTEN CONTRACT. RE' 7042 LAMPIIIER HIGH 6CHODL- AVOITIDRS 1, RENOVATIONS• 1570". t17H Sr., 9PRIRGFIELP, IL 62?02 R(: r04? LANP111ER HWH BC HCOL• Anp1TIONS a BENOVATIONS• 1700 H. t1TH or,, aPRNGF Ip 4O. It IRM amen Dam6lllee Qnlrecsere In;. (xW1I Is Included me e named IPia1e6 through endwaamenL Werk -re CemPeneerlen eer4rayn [e pmuf6ad to ampluyeas le4sed to Qlean Damn lllen Cenlrodors Irb IMougb Reed Mir ii Edo* 1, LLC SAMPLE It rIULUr_K HAROLD O'SHEA BUILDERS, INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED GENERAL CONTRACTOR BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 3401 CONSTITUTION DR. ACCORDANCE WITH THE POLICY PROVISIONS. SPRINGFIELD, IL 02711 AUTHORIZED REPRESENTATIVE (V 1 VU8-LU10 ACUKIJ GORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Workers' Compensation and Employers' Liability Policy Named Insured I Endorsement Number GREEN DEMOLITION CONTRACTORS INC. 4840 S ST LOUIS AVE SUITE 100 CHICAGO, IL 60632 Policy Number Symbol: WLR Number: C51378325 Policy Period Effective Date of Endorsement 10/01/2022 TO 10/0112023 10-01-2022 Issued By (Name of Insurance Company) Indemnity Insurance Co. of North America Insert the pubey number. The remainder of the information is to be wnlploled ort y when this endorsement is issued subseouenI to the oreoafatien or the nollcv. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule ANY PERSON OR ORGANIZATION AGAINST WHOM YOU HAVE AGREED TO WATVF YOUR RIGHT OE'' Rf'COVERY 1N A WRIT^EN CONTRACT, PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO THE DA'Z'E OF LOSS_ For the states of CA, UT, TX, refer to state specific endorsements. This endorsement is not applicable in KY, NH, and NJ. The endorsement does not apply to policies in Missouri where the employer is in the construction group of code classifications. According to Section 287.150(6) of the Missouri statutes, a contractual provision purporting to waive subrogation rights against public policy and void where one party to the contract is an employer in the construction group of code classifications. For Kansas, use of this endorsement is limited by the Kansas Fairness in Private Construction Contract Act(K.S.A.. 16-1801 through 16-1807 and any amendments thereto) and the Kansas Fairness in Public Construction Contract Act(K.S.A 16-1901 through 16-1908 and any amendments thereto). According to the Acts a provision in a contract for private or public construction purporting to waive subrogation rights for losses or claims covered or paid by liability or workers compensation insurance shall be against public policy and shall be void and unenforceable except that, subject to the Acts, a contract may require waiver of subrogation for losses or claims paid by a consolidated or wrap-up insurance program. Authorized Representative WC 00 03 13 (11/05) Copyright 1983-2017, National Council on Compensation Insurance, Inc. All Rights Reserved SAMPLE ���►���' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 10/05/2022 PRODUCER THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION Mark Mackey Ins Agcy ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 3338 W Foster HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Chicago, IL 60625 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURED GREEN DEMOLITION CONTRACTORS INC 4840 South St. Louis Avenue Suite 100 Chicago, Il 60632 INSURERS AFFORDING COVERAGE INSURERA:State Farm Mutual Auto Insurance C INSURER B: INSURER C: INSURER D: INSURER E: 25P8 NAIC # THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HER FIN IS RJR. IFrT Tn AI I THF TFRAAC FVr1 1IQInldc AKill rnLinrr n io — ­ POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR A00% POLICY EFFECTIVE POLICY EXPIRATION LTR INIVTD TYPE OF INSURANCE POLICY NUMBER DATE (MMID2M DATE MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE i REIJfEO LIABILITYLAIAGE I -J OCCUR j7.m'=GENERALL=r P sQNA� a �spv Inuu YID ; - GENERAL AGGREGATE - GENLAGGREGATEUMITAPPLIESPER PRODUCTS -COMP/OPAGG S PRO-"CJECT POLICY E - A X AUTOMOBILELIABILITY E615564 -B28-13 AUG -31-22 AUG -31-2.3 COMBINED SINGLE LIMIT S 5,000,000 X ANY AUTO (Ee accident) X ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY $ X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) 4, E LIABILITY AUTO ONLY - EA AGI QL; IST _ . $ ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG S EXC4SSIUMBHELLA LIABILITY OCCUR CLAIMS EACH OCCURRENCE _ lJ MADE AGGREGATE DEDUCTIBLE E RETENTION $ WORKERS COMPENSATION AND WCY_1JMI- STATUOTH- EMPLOYERS' LIABILfTY T RT _ ER ANY PROPRIETOR/PARTNERIEXECUTIVE E L. EACH ACCIDENT OFFICERIMEMBER EXCLUDED? - -- _ If yes, describe under E L DISEASE - EA.EMPWY s SPECIAL PROVISIONS helow EL DISEASE - POUCY LIMIT OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS RE:'/042 Lanphier high School -Additions and Renovations -1300 N 11th St, Springfield, IL 62702 Additional Insured with respect to General LiabiliLy and Hired & Non Owned Auto Liability (Umbrella follow form) on a Primary & Non -Contributory basis when required by written contract per TSO Forms CG 2010 10/01 and CG 2037 10/01 for work performed by Green Demolition Contractors, Inc. A Waiver of. Subrogation in favor of Additional_ Insureds with respect to General Liability an Hired & Non Owned Auto LiabiliLy(Umbrella follows form) when required by written contract is included per ISO form CG 2404(05/09) Harold O'Shea Builders, Inc AC)..eZ4 Public School District 186(Owner); and BLDD(Architect) .. M I rrraanr a "WL"cr% UANL:tLL.A I IVN HAROLD O' SHEA BUILDER'S INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION GENERAL CONTRACTOR DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 70 DAYS WRITTEN 3401 CONSTlTUTION DR NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL SPRINGN'LELD IL 62711 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. ACORD 25 (2001NB) The registration notices indicate ownership of the marks 6y their respective owners OACORD CORPORATON 1988, 2007132849 03-13-2007 I All rghts rosarvud SAMPLE ACORD 25 (2001108) AUTHORIZED REPRESENTATIVE MARK MACKEY IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. SAMPLE ACORD 25 (2001/08) _^ • n e P •�.,�� ��� 1, ffive o PUT]= V Ayvrmftms � a b training 15 as Io ea 4 REVISED August 93, 2004 ILL! �� �cr9isfier/ian � �. � c�eart3fae-� of �a6ar ).f4 J7AAlIAlJffG�41', Appmnl�p `�rafmn9= �tmp� j/er art�L�a' bar [Senuices .; 4,A& of .4yrr'&r.,ts wr egr- 4, Poo- ratiml (9pwjzq-q� -eacd # fgo r Y&M ". n ¢�coran�e eva'casr'e s¢na� 042p,preYices,6p 4 5, .2d D2 D�cf. 409790/73 .�s�rtafi�/Isvl xo, A o�4e�y e C ,eCrefary ll4rltafl%'o�C ��f.1�f` �lyL?fa;� F R�Swf�pf/tr�p¢' x'fC^/L GREEN DEMOLITION CONTRACTORS INCORPORATED 523 Northbrook Drive Michigan City, IN 46360 312-409-4771 Main References Private Amereco Engineering 54 Michigan Avenue Valparaiso, Indiana 46383 Mr. Jack Heine / Mr. John Blosky 219-531-0531 CR Realty Advisors 325 West Huron Chicago, I160654 Mr. Josh Nadolna Cell: 847.721.7906 Office: 312.332.7100 Brown & Momen, Inc. 823 East Drexel Square Chicago, IL 60615 Mr. David Clark 312-788-0770 Sterling Renaissance Builders 430 East Illinois Rte 22 Lake Zurich, Illinois 60047 Mr. Bruce Sterling 847-307-4400 ext 223 Rockford Construction Grand Rapids, MI 49508 Brock Burgess 616-437-4226 LaPorte, In "Recycling Today For A Greener Tomorrow"