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HomeMy WebLinkAboutOpening of Bids - 2023 Water Utility Service Line Repair Program - Bob Frame Plumbing Services, Inc.BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 01/12/2023 Name Theresa Heffner Department: PW BPW Date 01/19/2023 Phone Extension 9253 Review and Approval Required Prior to Submittal to Board Diversity Compliance ❑ Officer Name and Inclusion Officer BPW Attorney X Attorney Name Michael Schmidt Dept. Attorney ❑ Attorney Name Purchasing ❑ Check the Appropriate Item Type — Required. for All Submissions ❑ Professional Services Agreement ❑ Contract ❑ Proposal ❑ Open Market Contract ❑ Amendment/Addendum ❑ Special Purchase, QPA ❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet ❑ Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes ❑ Proposal Opening ❑ C/O & PCA No. ❑ PCA ❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution X Other: Special Action Item n Ease./Encroach Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description Information Bob Frame Plumbing Services, Inc. ❑ Yes ❑ If Yes, Approved by Purchasing X No E] MBE ❑ WBE Completed E-Verify Form Attached ❑ Yes ❑ 2023 Water Utility Service Line Repair Program PR - Additional Bid received for January 10, 2023 Board Meeting. Memo Attached For Chance Orders Onl Amount of ❑ Increase $ ❑ Decrease ($ ) Previous Amount $ Increase Current Percent of Change: Decrease New Amount $ Increase Total Percent of Change: Decrease Time Extension Amount: New Completion Date: � �Spi3TH Bz.�O w y .t�>✓nct x s 1865 INTEROFFICE MEMORANDUM BOARD OF PUBLIC WORKS TO: Members of the Board of Public Works Michael Schmidt, Assistant City Attorney FROM: Theresa Heffner, Clerk to the Board of Public Works SUBJECT: 2023 Water Works Utility Service Line Repair Program Agenda Request — Opening of Bids DATE: January 11, 2023 On Friday, December 30, 2022 at 4:13 p.m. Carol Laskowski from Bob Frame Plumbing Services, Inc. submitted an application for the 2023 Water Works Utility Service Line Program. At 4:04 p.m. on the same day, Ms. Laskowski also submitted an application for the 2023 Sewer Insurance Program. The sewer item was not being opened at the January 10, 2023 board meeting, so submissions were to be sent to Larry Parker, Kevin Dombrowski, and Kim Thompson. When I received the application for the 2023 Water Works Utility Service Line Program, I confused it with the one for the sewer and did not place it into the proper bid folder for the bid opening on January 10, 2023. Due to this error, the bid was not read into the record. This was in error, so we are asking for the Board to accept and approve the opening of this bid as it was submitted on time. The inclusion of this bid did not negatively impact any other submissions. Fj Reply I (K) Reply All I —� Forward , ••• O-111,1erWorkslltility Service Line Repair Prog,ampdf 753 KB Attached is our 2023 application for Water Works Utility Service Line Repair Prcgram, Thankycu, Carol Lesk.—ki/Office Manager Rob Frame Plumbing Services, Inc, 574-291-7511 IN LICENSE NO, PC88700840 December 30, 2022 Board of Public Works County City Building, Room 1316 227 W.lefferson Blvd. South Bend, IN 46601 bpwbids@southbendin.gov Re: Water Works Utility Service Line Repair Program To Whom It May Concern: Bob Frame Plumbing Services, Inc. is currently in your Water Works Utility Service Line Repair Program and have been for many years. We have read the 4-page attached letter "Request For Applications" and meet the minimum specifications listed. Enclosed you will find the following: • Plumbing Corporation License #C081053737 • Plumbing Contractor Licenses for David P. Frame #PC88700840/Tyler M. Frame #PC11200080 • Copy of Performance Bond for $25,000 • Certificate of Insurance • Non -Collusion Affidavit, Non -Debarment Affidavit, Employment Eligibility Verification, and Non - Discrimination Commitment Form, Bob Frame Plumbing Services, Inc. is interested in continuing the program and accepts the stated conditions/requirements. Thank you for your time and consideration. Sincerely, Tyler M"Frame, President Indiana Professional Licensing Agency Indiana Plumbing Commission • :" , :c 402 W. Washington street, W072 Indianapolis, IN 46204 ral Plumbing Corporation License Number Ezpire Date' C081063737 12/31 /2023 Bob Frame Plumbing Services, Inc Eric J. Holcomb Governor Slate of Indiana Deborah J. Frye Executive Director Indiana Professional Licensing Agency Indiana Professional Licensing AHency 402 W. Washington Street, W072 Indianapolis, IN 46204 Plumbing Corporation Liconso Numbor Expire Dole C081053737 1213112023 Bob Frame Plumbing Services, Inc al�m Indiana Professional Licensing Agency Indiana Plumbing Commission 402 W. Washington Street, W072 Indianapolis, IN 46204 rare Plumber Contractor ' License Number Expire Dato PC88700840 12/31/2023 DAVID P FRAME Eric J. Holcomb Deborah J. Frye Governor Executive Director State of Indiana Indiana Professional Licensing Agency Indiana Professlonat Licensing Agency 402 W. Washington Street, W072 Indianapolis, IN 46204 Plumber Contractor Llcanse Number E%Pirs Dale PC86700840 12131 /2023 DAVID P FRAME alon„u,. Indiana Professional Licensing Agency Indiana Plumbing Commission 402 W. Washington Street, W072 Indianapolis, IN 46204 ti Plumber Contractor Tyler M. Frame Eric J. Holcomb Deborah J. Frye Governor Executive Director State of Indiana Indiana Professional Licensing Agency Intllana Professional Licensing Agency 0.02 W. Washington Street, W072 •� Indianapolis, IN 40204 Plumber Contractor License Number Expir Dels PC71200000 1213712023 Tyler M. Frame Continuation Certificate PLUMBING CONTRACTOR IN CONSIDERATION of the payment of a premium of $ 100.00 Federated Mutual Insurance Company hereby continues in force to 07A2-2023 Is bond No. 607575u effective 07l12/201$ in the sum of TWENTY-FIVE THOUSAND AND NO/100-- Dollars ($ 25,000.00 ), on behalf of BOB FRAME PLUMBING SERVICES INC represented by (if applies CITY OF SOUTH BEND OF PUBLIC WORKS Obligee subject to ali its terms, conditions and limitations as set forth and expressed in said bond. Principal, in favor of This certi(Icale is executed upon the express condition that the Company's liability under said bond and this and all continuation certificates Issued in connection therewith shall not be cumulative, and shall not in any event exceed the amount set forth in said bond, or said amount as it may have been increased or decreased by any rider(s) or endorsement(s) properly issued by the Company. Dated this 31ST day of MAY 2022 Federated Mutual Insurance Company By MICHtwLIE KRAAY Attorney -in -Fact lNSUMMEf PO Box328 Owatonna, MN 55060 er-22 ,Ed: OtdB POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That FEDERATED MUTUAL, INSURANCE COMPANY, a corporation duly organized and existing under the laws of the State of Minnesota, and having its principal office in the City of Owatonna, State of Minnesota, does hereby constitute and appoint: MICHEILE KRAAY OWATONNA of the City of State of MINNESOTA its true and lawful attorney for the following purposes: To sign its name as surety to, and to execute, affix the seal, acknowledge and deliver any and all surety bonds and penalties not exceeding: ONE HUNDREDTHOUSAND DOLLARS ($i00,000) EACH .BOB FRAME PLUMBING SERVICES INC SOUTH BEND IN The execution of such bonds or undertakings in pursuance of these presents shall be binding upon the Company as if they had been executed and acknowledged by the regularly elected officers of the Company. This Power of Attorney granted by Federated Mutual .Insurance Company shall terminate when the designee ceases to be: I) Employed by Federated Mutual Insurance Company or 2) Employed by Federated Mutual Insurance Company in a job for which such Power of Attorney is required. IN WITNESS WITETtEOF, the said FEDERATED MUTUAL INSURANCE COMPANY has caused this instrument to be signed and its corporate seal to be affixed by its Executive Vice President and Assistant Secreta,ythis.the 1ST day of FEBRUARY 2020 FEDERATED MUTUAL INSURANCE COMPANY BY 4:�nb,�,,v���Q /Zjevt/ LSEAL); �xecutivVicesiden and BY As ' tantSecretary STATE OF MINNESOTA COUNTY OF STEELE On this 1ST day of FEBRUARY; 2020 personally appeared before me, the undersigned notary pablia, James A. Thon end Jonathan R Hanson to me personally known, who, each being duly sworn by me, did say that they are respectively the Executive Vice President and Assistant Secretary of the FEDERATED MUTUAL INSURANCE COMPANY and that the'seal affixed to this instrument is the corporate seal of said Corporation and that this instrument was signed and sealed of behalf of said Corporation by authority of its Board of Directors and said James A. Thon and. Jonathan R. Hanson acknowledge said instrument to be the free act and deed of said corporation. N,1 C r 3 - 01 COPY OF RESOLUTION "EE IT RESOLVED that the President or any Vice President in conjunction with the Secretary is hereby authorized and empowered under the corporate seal of the Company, to appoint any person or persons as attorney or attorneys-in4act, or agent or agents of the Company, in its name and as its act to execute and deliver, anywhere in the United States or Canada, any and all bonds and undertakings of suretyship and other documents that the ordinary course of surety business may require.' "IIE IT FURTHER,RESOLVED that the Power of Attorney or other document appointing such person or persons as attorney or attorneys -in -fact or agent or agents of the Company may either be personally signed by the President, any Vice President, the Secretary or may be executed by said officers by means of facsimile signatures. The said personal signatures or facsimile signatures shall not require the Company seal or any other seal and shall be valid and binding on the company if executed either by personal signature or facsimile signature and with or without the Company seal being affixed thereto." I, the undersigned, hereby certify that I am a Executive Vice President of the FEDERATED MUTUAL INSURANCE COMPANY, a Corporation duly organized and existing under the laws of the State of Minnesota and that the foregoing is a true and complete copy of the original Power of Attorney given by said Company to: MICNELLE KRAAY of OWATONNA, MINNESOTA autfiorizing and empowering such person to sign bonds as therein set. forth, which Power of Attomey has never been revoked and is still in full force and effect. I further certify. that said Power of Attorney. was given in pursuance of a resolution adopted at a regular meeting of the Board of Directors of said Company duly called and held at the office of the Company in the City of Owatonna, Minnesota on the 201h day of AIWb 14 82 at which meeting quorum was present and that the foregoing is a true and correct copy of said resolution, and the whole thereof as recorded in the minutes of the said meeting. PURSUANT to the By -Laws of Federated Mutual Insurance Company, Article 8, Section I; in the absence of or inability of the Secretary to act, his duties shall be performed by the Assistant Secretaries in the order of their rank; IN TESTIMONY WHEREOF, I have hereunto. set my hand and affixed the seal of the FEDERATED MUTUAL INSURANCE COMPANY this the 31ST day of MAY 2022 u mare,. FEDERATED MUTUAL INSURANCE COMPANY (SEAL)` xecutive Vice President ACOR 7 L� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDAYYY) I 02/16rz022 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 hostler 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 hostler in lieu of such endorsements . PRODUCER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 CONTANAME: CT CLIENT CONTACT CENTER n pa/cNo E.t : 888-333-4949 n/c No): 5074464664 OWATQNNA, MN 55060 ADDRESS: CLIENTCONTACTCENTER FEDINS.COM INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 264-429-2 INSURER B: INSURER C: BOB FRAME PLUMBING SERVICES INC 2442 JACLYN CT SOUTH BEND, IN 46614-3700 INSURER D: INSURER E: INSURER F: 22 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. INS L R A X TYPE OF INSURANCE COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR ADDL INSR Y SUBR D N POLICY NUMBER 9403507 POLICY EFF MM/DOIVYYV 04/01/2022 POLICY EXP MMIDDIYVYY 04/Oi/2023 LIMITS EACH OCCURRENCE $1,000,000 DAMAGE TO RENTE PREMISES E occurrence $100,000 LIED EXP (Any one person) EXCLUDED PERSONAL a ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 AGGREC TE LIMIT APPLIES PER: PROJECT ❑LOC POLICY LJ u OTHER: OEN'L X PRODUCTS - COMPIOP AGO $2,000,000 A AUTOMOBILE LIABILITY MY AUTO OWNED AUTOS ONLY 60HEEDULED NON -OWNED HIRED AUTOS ONLY H AUTOS ONLY N N 9403507 04/01/2022 04/01/2023 EOa MBmeD SINGLE LIMIT $1,000,000 X BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY Per accidemil DAMAGE A X UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE N N 940350E 04/01/2022 04/01/2023 EACH OCCURRENCE $2,000,000 AGGREGATE $2,000,000 DED RETENTION A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIE%ECUTIVE OFIFICERIMEMSER E%CLUDEDT (Mandalantlalory in NH) N yea, describe under DESCRIPTION OF OPERATIONS below N/A N 9403509 04/01/2022 04/0112023 X PER STATUTE OTN- ER E.L. EACH ACCIDENT $5OO,000 E.L. DISEASE - EA EMPLOYEE $5001000 E.L DISEASE -POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be aaacnad It more space Is required) THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS/ LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY. 264429-2 220 CITY OF SOUTH BEND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 227 W JEFFEHSON BLVD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SOUTH BEND, IN 46601-1830 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 4" © 1988-2015 ACORD.CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 3312 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED =OWNERS, LESSEES OR CONTRACTORS = AUTOMATIC STATUS WHEN REQUIRED IN A WRITTEN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II -Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, .approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. However, the insurance afforded to such This exclusion applies even if the claims additional insured: against any insured allege negligence or other 1. Only applies to the extent permitted by law; wrongdoing in the supervision, hiring, and employment, training or monitoring of others 2. Will not be broader than that which you are by that insured, if the "occurrence" which required by the contract or agreement to caused the "bodily injury" or "property provide for such additional insured, damage", or the offense which caused the "personal and advertising injury". involved the A person's or organization's status as an rendering additional insured under this endorsement ends engineering or when your operations for that additional insured professionall or the failure architectural, ento render any are completed. surveying services. © Insurance Services Office, Inc., 2018 Page 1 of 2 CG 20 33 12 19 Policy Number: 9403507 Transaction Effective Date: 04/01/2022 2. "Bodily injury" or "property damage" occurring after: a. 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 additional insured(s) at the location of the covered operations has been completed; or b. 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 contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement you have entered into with the additional insured; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 2 of 2 ©Insurance Services Office, Inc., 2018 CG 20 33 12 19 Policy Number: 9403507 Transaction Effective Date:04/01/2022 When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this AffiAavit. 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) ) SS: 30z Cph 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 ($2Q000,000) 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 Nan-Debarnrent 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 Depaitment 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 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, 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 MBE/WBE; however, it may not unlawfully discriminate against said WBE/MBE. 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-Ca➢nsion Non-Debament Affidavit Non Iran Fomi Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the performance of this contract with privileges of employment, or any matter directly or indirectly related to employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation, handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of contract. I, the undersigned bidder or agent as contractor on a public works project, understand my statutory obligations to the use of steel products or foundry products made in the United States (LC. 5-16-8-1). I hereby certify that I and all subcontractors employed by me for this project will use steel products or foundry products made in the United States on this project if awarded. I understand I have an affirmative duty to notify the City in my bid that my proposal does not include the use of steel products or foundry products made in the United States. I understand it is my sole obligation and responsibility to provide a justification to the City, subject to review and approval, why the cost of United States made steel or foundry products is unreasonable. Prior to award and upon submission of bid which does not use steel products or foundry products made in the United States, the City, through its director of public works, shall make a determination if the price of United States made steel or foundry is unreasonable. I understand that violations hereunder may result in forfeiture of contractual payments. I hereby affnm under the penalties of perjury that the £acts and information contained in the foregoing bid for public works are true and correct. Dated this s��o-� day of l�}P 20 a �1 Contractorr/�/Bidder (Firm) I 'J' t 'A7• � Signature of Contractor/Bidder or Its Agent Printed Name and Title Subscribed and sworn to before me this � day of ��e orvlloeC� , 20� My Commission Expires L1- L c - A 1r County of Residence Non -Collision Non -Debarment Affidavit Non lran Form ��O I Notary Public �S SE�I�C