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Home My WebLink AboutOpening of Bids - 2023 Water Works Utility Service Line Repair Program - Niezgodski Plumbing Inc.Niezgodski Plumbing, Inc. Plumbing and Heating Contractor PO Box 3096 South Bend, IN 46619 Phone: (574) 233-9774 Fax: (574)233-9752 e-mail: Niezplumgcomcast.net Indiana State License #PC88701935 Established 1922 January 6th, 2023 City of South Bend Board of Public Works, 131h Floor County City Building, Room 1316 South Bend, IN 46601 Attached please find the required documents as requested for the Water Works Utility Service Line Repair Program. Niezgodski Plumbing Inc. has been providing reliable plumbing service in South Bend for over 100 years now. In addition we have been performing water service leak repairs and stop box repairs for the City of South Bend since 1972. Our 4"' Generation fancily owned business employs qualified and dedicated employees. From day one, instilled in all of our employees is the ethics of hard work. It is stressed that an attitude of honesty and integrity shall always be prevalent. As representatives of the City of South Bend, during the course of performing Water Works Repairs we realize that our performance serves as a front line view of how South Bend residents judge the delivery of one of the City's most essential services. Safe drinking water available to all city residents with minimal interruption, is of utmost essence for any cty's administrative and departmental success. Niezgodski Plumbing Inc_, will continue to deliver these services to the City of South Bend and view them as our highest priority. We are fully equipped to handle all Water Works repairs, including every manner of emergency service required. We have all the necessary tools and equipment and they are kept fully maintained. We meet all of the requirements called for in the specifications of the Board of Public Works Request for Proposals regarding the Water Works Utility Service Line Repair Program. In addition we acknowledge that these repairs must be performed in any and all adverse weather conditions. In addition, Niezgodski Plumbing Inc. shall also be responsible for the preparing and pouring or subcontracting of all sidewalk, driveway and street cuts, according to City specifications. Included please find all required Commercial General Liability Insurance information, Workers Compensation Insurance, required performance bond information and a copy of my Plumbing Contractors License and Corporate Plumbing License. Also included is the signed and notarized Non -Collusion Affidavit, Non -Debarment Affidavit, Employment Eligibility Verification and Non -Discrimination Commitment Form. I sincerely hope to have the opportunity to continue representing the needs of the South Send City Water Works in every manner necessary, for many future years to come. Please do not hesitate to contact me if there is anything further you may require. Sincer , Grant Niezgodski Treasurer, Niezgodski Plumbing Inc. 574-233-9774 niezplum@comcast_net 12/12/2022 2:31.13 PM License $125.00 Check 34141 $ 125.00 ddecocke 57846 No. 002468-23 REGISTRATION $125.00 ST. JOSEPH COUNTY AND CITY OF SOUTH BEND, INDIANA December 12, 2022 WHEREAS, DAVID L. NIEZGODSKI, dba NMZGODSIU PLUMBING, INC. having this day paid to the Building Department the sum of One Hundred Twenty Five Dollars and Zero Cents is hereby REGISTERED to operate in the unincorporated areas of ST. JOSEPH COUNTY and the CITY OF SOUTH BEND, as a Plumbing Contractor THIS REGISTRATION EXPIRES: December 34 2023 Building Commissioner Randy James P.O. BOX 3096 SOUTH BEND, IN 46619 (574)233-9774 THIS REGISTRATION IS NOT TRANSFERABLE _ _ Indiana Professional Licensing Agency � ye € i= 402 West Washington Street, Room W072, Indianapolis, Indiana 46204 (3I7)234-8800 ` fr PLUMBING CORPORATION C089200225 12/31 /2023 Active' NIEZGODSKI PLUMBING, INC. 232 N. Mayflower Rd South Bend IN 46619 I I Eric J. Holcomb Deborah J. Frye Eric J. Holcomb Deborah J. Frve Governor Executive Director State of Indiana Indiana Professional Licensing Agency srnrE FORM 49122(R2r tb r Indiana Professional Licensing Agency 402 W. Washington Street, W072 6 Indianapolis, IN 46204 F Plumber Contractor License Number Expire Date PC88701935 12131/2023 l David L Niezgodski signature jorw 7 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 J_ I ) J ) SS: t 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 Non -Collusion Non -Debarment Affidavit Non Iran Form 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. 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 perforrning 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, partnerships, corporations, associations, or joint venturers awarded a contract by the City of South Bend through its agencies, boards, or commissions shall not discriminate against any employee or applicant for employment in the performance of a City contract with respect to hire, tenure, terms, conditions, or privileges of employment, or any matter directly or indirectly related to employment because of race, sex, religion, color, national origin, ancestry, age, gender expression, gender identity, sexual orientation or disability that does not affect that person's ability to perform the work. In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials, or any combination of the foregoing including, but not limited to, public works contracts awarded under public bidding laws or other contracts in which public bids are not required by law, the City, its agencies, boards, or commissions may consider the Contractor's good faith efforts to obtain participation by those Contractors 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. In no event shall persons or entities seeking the award of a City contract be required to award a subcontract to an MBEIWBE; however, it may not unlawfully discriminate against said WBEIMBE. A finding of a discriminatory practice by the City's MBE/WBE Utilization Board shall prohibit that person or entity 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 for 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. Non -Collusion Non -Debarment Affidavit Non Iran Fonn Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the performance of this contract with privileges of employment, or any matter directly or indirectly related to employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation, handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of contract. 1, the undersigned bidder or agent as contractor on a public works project, understand my statutory obligations to the use of steel products or foundry products made in the United States (I.C. 5-16-8-1). 1 hereby certify that I and all subcontractors employed by me for this project will use steel products or foundry products made in the United States on this project if awarded. I understand I have an affirmative duty to notify the City in my bid that my proposal does not include the use of steel products or foundry products made in the United States. I understand it is my sole obligation and responsibility to provide a justification to the City, subject to review and approval, why the cost of United States made steel or foundry products is unreasonable. Prior to award and upon submission of bid which does not use steel products or foundry products made in the United States, the City, through its director of public works, shall make a determination if the price of United States made steel or foundry is unreasonable. I understand that violations hereunder 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. f 23 Dated this day of . �, 20AP, ` F 1. (,(;- Printed . &-,a Name and Title Subscribed and sworn to before met&-Sclday f "21 My Commission Expir Notary c County of Residence �Y P� AURORA MACHADO, otA Notary Public z Within and for the county of St .lWP Rion -Collusion Non -Debarment Affidavit Dion Iran Form 0 SEAS and the state of Indiana �,� a Commission Number 663444lw) Worker's Compensation and Employer's Liability JNDIANA IFARM Insurance Policy ,♦® BUREAU INSURANCE® Policy No. Transaction NEW BUSINESS WC 8341646 00 Policy Period From 08/21/2022 to 08/21/2023 12:01 A.M. Standard Time at the address of the Insured as stated herein Agent: Name and Phone Address !! GALVAN, BRANDON 2410 EDISON RD, SUITE 400 i 574-400-4389 SOUTH BEND IN 46615-3518 7601109762 1. Named Insured and Address NIEZGODSKI PLUM31NG, INC 232 N MAYFLOWER RD SOUT�i BEND IN 46619-1534 Carrier # FEIN # Risk ID # Entity of Insured 16454 199105098 CORPORATION Additional Locations: See Attached Schedule 2_ The Policy Period is from 08/21/2022 to 08/21/2023 12:01 a.m. Standard Time at the Insured's mailing address. 3. A. Workers Compensation Insurance: Part ONE of the policy applies to the Workers Compensation Law of the states listed here: Indiana B. Employers Liability Insurance: Part TWO of the policy applies to work in each state listed in Item 3A. The limits of our liability under Part TWO are: Bodily Injury by Accident $ 1, 000, 000 each accident Bodily Injury by Disease $ 1,000,000 policy limit Bodily Injury by Disease $ 1, 000, 000 each employee C. Other States Insurance: Part THREE of the policy applies to the states, if any, listed here: ALL STATES EXCEPT states designated in item 3_A., North Dakota, Ohio, Washington, Wyoming D. This policy includes these endorsements and schedules: See attached schedule. 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates, and Rating Plans. All information required below is subject to verification and change by audit. SEE EXTENSION OF INFORMATION PAGE Minimum Premium $ 582 Total Estimated Annual Premium $ Expense Constant $ Premium Discount $ Premium Audit Period: ® Annual; ❑ Semiannual; ❑ Quarterly; ❑ Monthly Countersigned: �,UGUST 22, 2022 Issued Date: 08/23/2022 8,084 160 0 2%,7-�/ 7 / Authorized Representative Issuing Office: P_O. Box 1250; Indianapolis, IN 46206-1250 WCPDEC 04ses INSURED Page 1 of 2 AMRINDIANA FARM BUREAU INSURANCE@ WORKERS COMP 8 EMPLOYERS LIABILITY Policy No. WC 8341646 00 Policy Period From 08 /21 /2022 to 08/21/2023 at 12:01 a.m. Standard Time at the described 10cation EXTENSION OF INFORMATION PAGE CLASSIFICATION OF OPERATIONS Code No, Classification Description Premium Basis Total Est. Annual Remuneration Rate Per $100 of Remuneration Estimated Annual Premium Indiana Rating Period 08/2/12022 through 08/21/2023 Site 00001 5183 PLUMBING NOC & DRIVERS 645,931 1_670000 10,787.00 8810 CLERICAL OFFICE EMPLOYEES - NOC 100,000 0_120000 120_00 Site 00001 Total S 10 , 907 _ 00 Total of Sites for Rating Period $ 10,907.00 Rating Period Total Rating Period 08/21/2022 through 08/21/2023 9812 EMPLOYER'S T.TABILITY INCREASED LIMITS 10,907 0_028000 305_00 9898 EXPERIENCE MODTFICATION 085 11,212 -0-140000 -1,570.00 9687 SCHEDULE RATING CREDIT 9,642 -0.200000 -1,928.00 160-00 0900 EXPENSE CONSTANT 0935 STATE ASSESSMENT/SECOND INSURY FUND 8,024 0.007500 60, 00 9740 TERRORISM 745,931 0.0TQ000 7S_00 9741 C2ITASTROPHE-OTHER TkiRN CERTIFIED ACTS OF TERRORISM 745,931 0.01000Q 75-00 $ -2 , 823 _ 00 Rating Period Total Total of all NON -SPLIT Classes $ -2 , 823 . 00 $ 10 , 907 _ 00 Total of all SPLIT Classes State Total $ 8 , 084 _ 00 Policy Total $ a , 084 _ 00 Issued [Date: 06/23/2022 wcPbec o�07 IN SU REF Paue 2 of 3 Pont INDIANA FARM BUREAU INSURANCE® Worker's Compensation and Employer's Liability Insurance Policy Policy No' WC 8341646 00 Policy Period From 08/21/2022 to 08/21/2023 at 12:01 a.m. Standard Time at the described location ENDORSEMENT SCHEDULE State Number Ed_ Date Description 13 WC000000C 01/15 WORKERS COMP/EMPLOYER'S L,IAB 13 WC000414A 01/19 NOTIFICATION OF CHG IN OWNER 13 WC000421F 01/22 CATASTROPHE (OTHER THAN CERTF) 13 WC000422C 01/21 TERRORISM RISK PROGRAM REAUTH 13 06-825 12/88 MUTUAL CONDITIONS 13 21-201WC 04/05 NOTICE TO POLICYHOLDERS Issued Date: 08/23/202- wcPFS 0494 INSURED Page 3 0= DATE (MMIDDIYYYY) A�oRo CERTIFICATE OF LIABILITY INSURANCE 01/041202308:48 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 Galvan, Brandon CONTACT NAME: _ PHONE (574)400-4389 Fax AIC Na '� E-MAIL Brand on.Galvan@infarmbureau ,com ADDRESS: 2410 Edison Rd, Suite 400 INSURERS AFFORDING COVERAGE NAIL# South Bend, IN 46615 IIVSURERA:—United Farm Family Mutual Insurance Company 15298 INSURED _ INSURER B : INSURERc_— NIETGODSKI PLUMBING, INC 23214 MAYFLOWER RD SOUTH BEND, IN 46619-1534 INSURER D: INSURER E : INSURER F : rrVERAr_Ec GERTIFICATiF NUMRFR: 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 LTR TYPE OF INSURANCE ADDL SUBR V POLICY NUMBER POLICY EFF MMfDDlYYYY POLICY EXP MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx_1 OCCUR ; BOP8236911 08121 /2022 08121 /2023 €€ EACH OCCURRENCE I $ 1 000 000 DAMAGE TO RENTED PREMISES (Ea occurrence $ 50 000 MED EXP (Any one person) $10000 PERSONAL & A➢v INJURY $1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: X � PRO - POLICY u LOG OTHER: GENERAL AGGREGATE $ 2 000 000 PRODUCTS - COMPIOP AGG $ 2 000 000 A AUTOMOBILE LIABILITY ANY AUTO OWNED X SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED X AUTOS ONLY X AUTOS ONLY CAP8524976 0912112022 08/21 /2D23 EO BINEDtSINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ BODILY INJi1RY (Peraccidenl) $ PROPERTY DAMAGE Per accident $ I $ A X UMBRELLALIAB EXCESS LIAB OCCUR CLAIMS -MADE UMBS609087 08/21/2022 I �08/21/2023 EACH OCCURRENCE $ Ll AGGREGATE $2,000,000 -- DED RETENTION $10,000 ! $ A WORKERS COMPENSATION ANU EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNER1EXECUTiVE YIN OFFICER/MEMBEREXCLUDEO? (Mandatary in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NrA WC 8341646 08l21/2022 08I2112023 X, PER OTH- STATUTE ER -- -" ""--"- E.L. EACH ACCIDENT $ 1 000 000 ; E.L. DISEASE - EA EMPLOYEE $ 1,0 D0,000 E.L. ➢ISEASE - POLICY LIMIT $ 1.000.000 I DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) L"=Iz41I2LMl 3 City of South Bend Board of Public Works 227 W Jefferson Blvd #1316 South Bend, IN 46601 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL 13E DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Galvan, Brandon v raoV-cV r.. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD %My Effective Date: January 4th 2023 Western Surety Company LICENSE AND PERMIT BOND KNOW ALL PERSONS BY THESE PRESENTS: Bond No_ 66497699 That we. Niezgodski Plumbing, Inc of South Bend State of Indiana , as Principal, and WESTERN SURETY COMPANY, a corporation duly licensed to do surety business in the State of Indiana , as Surety, are held and firmly bound unto the city of south Bend and saint Jose h Gount State of Indiana , as Obligee, in the penal sumof Twenty Five Thousand and 00/100 DOLLARS( 25 000.00 ), lawful money of the United States, to be paid to the Obligee, for which payment well and truly to be made, we bind ourselves and our legal representatives, firmly by these presents. THE CONDITION OF THE ABOVE OBLIGATION IS SUCH, That whereas, the Principal has been. licensed Perf by the Obligee. NOW THEREFORE, if the Principal shall faithfully perform the duties and in all things comply with the laws and ordinances, including all amendments thereto, pertaining to the license or permit applied for, then this obligation to be void, otherwise to remain in full force and effect until January 4 th 2024 , unless renewed by Continuation Certificate. This bond may be terminated at any time by the Surety upon sending notice in writing, by First Class U.S. Mail, to the Obligee and to the Principal at the address last known to the Surety, and at the expiration of thirtyL-06"35) days from the mailing of said notice, this bond shall ipso facto terminate and the Surety shae llieved from any liability for any acts or omissions of the Principal subsequent to said dat& s :.o the number of years this bond shall continue in force, the number of claims made a dizisXs boo Jfi A 'the number of premiums which shall be payable or paid, the Surety's total limit of li Whty shall not be 44 anulative from year to year or period to period, and in no event shall the Surety's total liability Torn all `claimsIxceed the amount set forth above. Any revision of the bond amount shall not be g �rtgd � i1� MOWN Date is 5th day of January _ 2023 Niez ndski Plumbin Inc. Principal Principal WESTE zPaul 4Ba4tVice MPANY By President Form 532-5-2021 STATE OF SOUTH DAKOTA COUNTY OF MINNEHAHA ACKNOWLEDGMENT OF SURETY (Corporate Officer) On this 5th day of January 2023 , before me, the undersigned officer, personally appeared Paul T . Bruf tat ; who acknowledged himself to be the aforesaid officer of WESTERN SURETY COMPANY, a corporation, and that he as such officer, being authorized so to do, executed the foregoing instrument for the purposes therein contained, by signing the name of the corporation by himself as such officer. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. S. GREEN FAQ=E_A�L [VOTARY PUBLIC SEAL o ary PublicSouth Dakota souTN UAl<oTA My Commission Expires: February 12, 2027 STATE OF ss COUNTY OF � On this day of ACKNOWLEDGMENT OF PRINCIPAL (Individual or Partners) before me personally appeared known to me to be the individual — described in and who executed the foregoing instrument and acknowledged to me that —he — executed the same. My commission expires Notary Public ACKNOWLEDGMENT OF PRINCIPAL STATE OF ss (Corporate Officer) COUNTY OF f On this day of before me personally appeared who acknowledged himselflherself to be the Of , a corporation, and that he/she as such officer being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing the name of the corporation by himseWherself as such officer. My commission expires Notary Public Q-. H z a a � � W a cu a U °T d � O N d z.� 0 a a � � •� r11 Western Surety Company POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That WESTERN SURETY COMPANY, a corporation organized and existing under the laws of the State of South Dakota, and authorized and licensed to do business in the States of Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, and the United States of America, does hereby make, constitute and appoint Paul T. Bruflat of Sioux Falls State Of Sough Dakota , its regularly elected Wi ce Presiden as Attorney4n-Fact, with full power and authority hereby conferred upon him to sign, execute, acknowledge and deliver for and on its behalf as Surety and as its act and deed, the following bond: One bond with bond number for Niez odski Plumbin Inc as Principal in the penally amount not to exceed: $ 25 000. 00 Western Surety Company further certifies that the following is a true and exact copy of Section 7 of the by-laws of Western Surety Company duly adopted and now in force, to -wit: Section 7. All bonds, policies, undertakings, Powers of Attorney, or other obligations of the corporation shall be executed in the corporate name of the Company by the President, Secretary, any Assistant Secretary, Treasurer, or any Vice President, or by such other officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys -in -Fact or agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal may be printed by facsimile. In Witness Whereof, the said WESTERN SURETY COMPANY has caused these presents to be executed by its Vice President with the corporate seal affixed this 5th day of January 2023 ATTEST L. Bauder, Assistant Secretary WESTE N/URET COMPANY i3yG�-- Paul T rufiat, Vice President �4g}it►tYrsiJ.1'fi��- ,,�'�� f�96 • .. �. 'tea STATE OF SOUTH DAKOTA ss COUNTY OF MINN[ 'i14Elli#6EIllS}�b': On this 5th day of January 2023 , before me, a Notary Public, personally appeared Paul T. Bruflat and L. Bauder who, being by me duly sworn, acknowledged that they signed the above Power of Attorney as Vice President and Assistant Secretary, respectively, of the said WESTERN SURETY COMPANY, and acknowledged said instrument to be the voluntary act and deed of said Corporation. #y44�4�44s+s*��sae4�a4segebwo4 { a M. BENT 8 s p 'rs � NOTARY PUBLIC $EAIL a SOUTH DAKOTA Notary Public }44kh+gh444bbhhsbbbyM+eoab$ My Commission Expires March 2, 2026 `t"n validate bond authenticity. ao to www.enasnrety.Gom > Owner/Obligee Services > Validate Boxed Coverage. Form F1975-11-2022 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 01/03/2023 Name Ken Smith Department Water BPW Date 01 /05/2023 Phone Extension 6108 Review and Approval Required Prior to Submittal to Board Diversity Compliance ❑ Officer Name and Inclusion Officer BPW Attorney ® Attorney Name Dept. Attorney ❑ Attorney Name Purchasing ® Mickey Lovy Check the Appropriate Item I Professional Services Agreement ❑ Contract ❑ Open Market Contract ❑ Bid Opening ® Quote Opening ❑ Proposal Opening ❑ Chg. Order, No. I -I Other: Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description Michael Schmidt ❑ Amendment/Addendum ❑ Bid Award ❑ Quote Award ❑ C/O & PCA No. ❑ Traffic Control Information All Submissions U Proposal ❑ Special Purchase, QPA ❑ Req. to Advertise ❑ Title Sheet ❑ Reject Bids/Quotes ❑ PCA ❑ Resolution Ease./Encroach Yes U If Yes, Approved by Purchasing ❑ No El MBE ❑ WBE Completed E-Verify Form Attached ❑❑ Yes No Water Works Utility Service Line Repair Program Water Utility 620-06-604-606-43 9015 Water Works Utility is soliciting applications from qualified vendors to participate in its Service Line Repair Program at the rates herein for the 2023 calendar year. For Change Orders Only Amount of ❑ Increase $ ❑ Decrease ($ ) Previous Amount Current Percent of Change New Amount Increase % Decrease ( % Increase % Total Percent of Change: Decrease % Time Extension Amount: New Completion Date: