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Opening of Bids - 2023 Traffic Calming Proj No. 122-014C - Premium Concrete Services
O4 �eU1H Bl�Q j. W, I CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK CHECKLIST FOR BIDDERS Project Name 2023 Traffic Project No. 122-014C For Bids Due April 119 2023 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 t/ or Bid Bond. / Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely ✓ executed. Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments / with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and 1/ Certification of use of United States Steel Products or Foundry Products. Proof of M/WBE Utilization Plans [MBE-1.0 and WBE-1.0]. Also provide Evidence of Good / Faith Efforts Forms [MBE-2.0 and WBE-2.0] and M/WBE Contacted Forms [MBE-2.1 and t/ WBE-2.11. V Acknowledge Receipt of Addandum(s) included with the bid. t/ All required additional information is included with the bid. / Proposal statements and other affidavits all signed by the proper party with name either ✓ printed or typed underneath signature. This checklist submitted with the Bid. This checklist is provided for bidder's use in assuring compliance with required documentation; however, it does not include all specifications requirements and does not relieve the bidder of the need to read and comply with the specifications. Bidder: FAEMrzu�w) COAkA TE SEAazeE5 Date: q//1 /z3 By Authorized Representative: Signature: Print Name &Title: Version 09/29/2021 Contractor's Bid for Public Works - 1 0l'RIh Document A310TM .2010 Bid Bond CONTRACTOR: (Name, legal status and address) Premium Concrete Services, Inc. 712 Richmond St SURETY: (Name, legal status and principal place of business) Old Republic Insurance Company P. O. Box 0941 Elkhart, IN 46516 Brookfield, WI 53008-0941 OWNER: (Name, legal status and address) City of South Bend, Indiana, Department of Public Works County City Building Room 1316 South Bend, IN 46601 BOND AMOUNT: Five Percent of the Total Bid 5 % of Total Bid PROJECT: (Name, location or address, and Project number, if any) 2023 Traffic Calming, Project No, 122-014C This document has important legal consequences. Consultation with an attorney is encouraged with respect to its completion or modification. Any singular reference to Contractor, Surety, Owner or other party shall be considered pluraI where applicable. The Contractor and Surety are bound to the Owner m 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 £till 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 thne for acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for an extension beyond sixty (60) days. If this Bond is issued in connection with a subcontractor's bid to a Contactor, 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, any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein. When so furnished, the intent is that this Bond shall be construed as a statutory bond and not as a common law bond. Signed and Seale 1 this 24th day of March 2023 Premium Concrete Services lop, (Principal) (Seat) ( itness) i A (Title) oo��gsV ��� NA Sviy; Old Republic Insurance Company (Surety) (Witness) �yyr xx rn (Title) Jan nif . Kaszni , Atorne In -Fact CAUTION: You should sign an original AIA Contract Document, on which t text appears in RED. An original assures M1I'in 1p° changes will not be obscured. Init, AIA Document A310^ —2010, Copyright @ 1963, 1970 and 2010 by The American Institute of Architects. All rights reserved. WARNING: This AIAe Document Is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this Ale Document, or any portion of It, may result In severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. f Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute or Architects' legal counsel, copyright@aia.org. 061110 * * * OLD REPUBLIC INSURANCE COMPANY POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That OLD REPUBLIC INSURANCE COMPANY, a Pennsylvania stock insurance corporation, does make, constitute and appoint: NICOLE L BICKNELL, MEGAN E RIESENBERG, MARK EDWARD WOBBE, BARBARA E PEARSON, JENNIFER L KASZNIA, SANDRA L JUNK, WILLIAM J CERNEY, 111, WESLEY MANTOOTH, THERESA BURNS, JORDAN SCHEMES, LISA M THOMAS, FAITH HUNT, PAMELA S. HIGGINBOTHAM of SOUTH BEND, IN iIS true and lawful Altorney(s)-in-Fact, with full power and authority for and on behalf of the Company as surely, to execute and deliver and affix the seal of the Company thereto (if a seal is required), bonds, undertakings, recognizances or other written obligations in the nature thereof, (other than self-insurance workers compensation bonds guaranteeing payment of benefits, or black lung bonds), as follows: ALL WRITTEN INSTRUMENTS IN AN AMOUNT NOT TO EXCEED TWENTY MILLION ($20,000,000) FOR ANY SINGLE OBLIGATION and to bind OLD REPUBLIC INSURANCE COMPANY thereby, and all of the acts of said Attorneys -in -Fact, pursuant to these presents, are ratified and confirmed. This appointment is made under and by authority of the board of directors at a meeting held on December 10, 2019. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the board of directors of the OLD REPUBLIC INSURANCE COMPANY on December 10, 2019, RESOLVED FURTHER, that the chairman, president or any vice president of the Company's surety division, in conjunction with the secretary or any assistant secretary of the Company, be and hereby are authorized and directed to execute and deliver, to such persons as such officers of the Company may deem appropriate, Powers of Attorney in the form presented to and attached to the minutes of this meeting, authorizing such persons to execute and deliver and affix the seal of the Company to bonds, undertakings, recognizances, and suretyship obligations of all kinds, other than bail bonds, bank depository bonds, mortgage deficiency bonds, mortgage guaranty bonds, guarantees of installment paper and not guaranty bonds. The said officers may revoke any Power of Attorney previously granted to any such person. RESOLVED FURTHER that any bond, undertaking, recognizance, or suretyship obligation shall be valid and binding upon the Company (i) when signed by chaff rmen, president or anyvice president 0f the Company's surety division and attested and sealed (ifa seal be required) by any secretary or assistant secretary; or (ii) when signed by a duly authorized Attorney -in -Fact and sealed with the seal of the Company (if a seal be required). RESOLVED FURTHER, that the signature of any officer designated above, and the seal of the Company, may be affixed by facsimile to any Power of Attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually affixed. IN WITNESS WHEREOF, OLD REPUBLIC INSURANCE COMPANY has caused these presents to be signed by its proper officer, and its corporate seal to be affixed this 30th day of November 2022 °°w:C'"%�,� OLD REPUBLIC SU A CE COMPANY ia -SEAL A35islan1 seCfBta Y �0 ' Vice President STATE OF WISCONSIN, COUNTY OF WAUKESHA- SS On this 30th day of November , 2022 , personally came before me, Alan Pavlic and Karen J. Haffner , to me known to be the individuals and officers of the OLD REPUBLIC INSURANCE COMPANY who executed the above instrument, and they each acknowledged the execution of the same, and being by me duly sworn, did severally depose and say: that they are the said officers of the corporation aforesaid, and that the seal affixed to the above instrument is the seal of the corporation, and that said corporate seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority of the board of directors of said organization. TR �'/% • �_ _cam, Notary Public My Commission Expires: September 28, 2026 CERTIFICATE (Expiration of notary's commission does not Invalidate this instrument) I, the undersigned, assistant secretary of the OLD REPUBLIC INSURANCE COMPANY, a Pennsylvania corporation, CERTIFY that the foregoing and attached Power of Attorney remains in full force and has not been revoked; and furthermore, that the Resolutions of the board of directors set forth in the Power of Attorney, are now in force. xau� 9, SEAL Signed and sealed at the City of Brookfield, WI this 24fh day of March 2023 45-5314 �Of1 ORSC t 109e (693) l4AS istant secttiy GIBSON INSURANCE AGENCY. INC. CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK Project Name 2023 Traffic Calming Project No. 122-014C For Bids Due April 11, 2023 PART (Must be completed for all bids. Please type or print) Date: q 11123 Bidder (Firm): PR��raa► CD.�JG2CPZ; SE�eJse�S Address: 7/.2 kxef aA)D ST. City/State/Zip: ri'14M XAI Telephone Number: (SAY ) 2&Y=O!4(o 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: 2oz3 ?Ra FFiC_ CAZ►'iX,.oVG the City of South Bend, Indiana, in accordance with plans and specifications prepared by: LOc IVAIIAELLkk 6ROu)0 and dated IV4AC P 20Z3 for the sum of (enter the Total Bid as shown on the Proposal) OacnxcroaA);WENa0oRCOEwury-Ez6iPrrNoasdO9VONaaaWsscwry($to488J28c) ) (Enter sum of Total Base Bid plus Alternates shown on Proposal) CNAIA0CF11 9(Numerical) The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the notice. Any addendums attached will be specifically referenced at the applicable page. If additional units of material included in the contract are needed, the cost of units must be the same as that shown in the original contract if accepted by the City of South Bend. If the bid is to be awarded on a unit basis, the itemization of the units shall be shown on a separate attachment. By I�Signalurq)�2 (Printed Name of Person Signing)) The above bid is accepted this Subject to the followinconditions: g BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Gary A. Gilot, Member ACCEPTANCE y da of 20 Joseph R. Molnar, Vice President Jordan V. Gathers, Member Murray L. Miller, Member Attest: Theresa Heffner, Clerk Version 09/29/2021 Contractor's Bid for Public Works - 2 rAM 1 11 or 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 (Le. persons or firms outside your own firm who have performed part of the work) that you have used on public works projects during the past five (5) years along with a brief description of the work done by each subcontractor. 3. If you intend to sublet any portion of the work, attach the name and address of each subcontractor, equipment to be used by the subcontractor, and whether you will require a bond. However, if you are unable to currently provide a listing, please understand a listing must be provided prior to contract approval. Until the completion of the proposed project, you are under a continuing obligation to immediately notify the City of South Bend in the event that you subsequently determine that you will use a subcontractor on the proposed project. 4. Attach a listing of equipment you have available to use for the proposed project. 5. Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing your proposal? If not, attach an explanation for the rationale used which would corroborate the prices listed. SECTION III CONTRACTOR'S FINANCIAL STATEMENT Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial statement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to the City of South Bend awarding the contract must be specific enough in detail so that said City of South Bend can make a proper determination of the bidder's capability for completing the project if awarded. Version 09/29/2021 Contractor's Bid for Public Works - 3 Premium Concrete Services, Inc. 712 Richmond Street Elkhart, IN 46516 (574) 264-0196 SECTION I EXPERIENCE QUESTIONAIRE 1) PUBLIC WORKS PROJECTS COMPLETED IN PAST YEAR: CONTRACT AMOUNT COMPLETIO N DATE OWNER $ 187,300.00 CURB & SIDEWALK 11/10/22 CITY OF ELKHART $ 387,923,00 CURB & SIDEWALK 11/14/22 CITY OF SOUTH BEND $ 217,860,00 CONCRETE PROJECTS 12/31/22 CITY OF ELKHART 2) PUBLIC WORKS PROJECTS IN PROGRESS: CONTRACT COM PLETI ON DATE OWNER _AMOUNT $ 570,000,00 STREETSCAPE 4/23/23 CITY OF ELKHART $ 568,005.00 CURB & SIDEWALK 6/16/23 CITY OF SOUTH BEND $ 481,500.00 CURB RAMPS & SIDEWALK 5/26/23 CITY OF ELKHART 3) HAVE NEVER FAILED TO COMPLETE ANY WORK THAT WAS AWARDED TO US. 4) REFERENCES: a. NISOURCE— MR. LUI(E BRADLEY-1039 PENNSYLVANIA AVE SOUTH BEND, IN 46601 b. COZIER MANUFACTURING —MR. I<EN MURR-402 N MAIN MIDDLEBURY, IN 46540 Premium Concrete Services, Inc. 712 Richmond Street Elkhart, IN 46516 (574)264-0196 SECTION II PLAN AND EQUIPMENT QUESTIONAIRE 1) Project: 2023 TRAFFIC CALMING -Schedule: After given the notice to proceed, Premium Concrete Services, Inc. will review, establish right-of- way, set up traffic control and layout area. We will then contact Indiana 811 to locate all utility lines within construction limits. Next will be inlet protection, removals, excavation, and grading with a 3-man crew. Then layout with 2-man crew. Forming, doweling, and pouring of concrete speed humps will be next with a 5-man crew. We may use subs for traffic control and hauling. Multiple crews may be working at the same time. Process will continue until all concrete and restoration work is complete. Subcontractors will follow installing signs and applying markings and striping. Project with be completed on schedule. 2) a) State Barricading Inc.- 24963 US 20 West South Bend, IN 46628 — Traffic Maintenance & Signs b) Acorn Landscaping —3680 W Sample St South Bend, IN 46619—Top Soil and Sodding c) V Class Logistics — 2213 St Charles Ave South Bend, IN 46614 - Trucking d) Hawk Enterprises— 1850 East North St Crown Point, IN 46307 - Electric e) KC Tree, Inc —8913 East US Hwy 20 New Carlisle, IN 46552 —Tree Removal f) A-1 Striping Service Inc. — 56825 Spirea Rd, New Carlisle, IN 46552 — Painting g) Milestone Fence LLC — 3723 N Home St Mishawaka, IN 46545 — Fencing h) Traffic Control Specialists — 1810 W Pacific Ave Knox, IN 46534 —Traffic Maintenance & Signs Premium Concrete Services, Inc. Does not require bonding for its subcontractors 3) Will supply list of subcontractors soon after award of project. 4) Equipment use for project: SI<id Steer, Mini Excavator, Excavator, Compactor, Roller, Walk -behind Saw, Cut-off Saw, Friction Screed, Dump Trucl<. Current plan is to used owned equipment, however depending on workload some rental equipment may be necessary. 5) Yes, Premium Concrete Services, Inc. has quotes for all materials in proposal. Premium Concrete Services, Inc. Elkhart, Indiana Annual Report December 31. 2021 Contents Report of Independent Accountant on Financial Statement ........................ 1 Financial Statements Statement of Income and Retained Earnings ................................ 2 BalanceSheet................................................................................ 3 Statement of Cash Flows................................................4....4..4%..... 4 Notes to the Financial Statements................................................0 5 - 8 Supplemental Schedules.. I ' 4 ' I ' ' L ' & ' ' I . . . . . . . I I . I d ' I I d L 4 1 4 * d I . 4 * 6 0 4 * P . . . . . . . 9 - 10 Anthony P. Dibley CPA, P.C. 3414 County Road 6 C Elkhart, Indiana 46514 (574)262-5027 I'ax (574) 264-4588 dibleyepa@maplenet.net INDEPENDENT ACCOUNTANT'S REVIEW REPORT To the Board of Directors Premium Concrete Services, Inc. Elkhart, Indiana I have reviewed the accompanying financial statements of Premium Concrete Services, Inc. (an S corporation), which comprise the balance sheet as of December 31, 2021 and 2020, and the related statements of income and retained earnings and cash flows for the years 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, I do not express such an opinion. Management's Responsibility for the Financial Statements Management is responsible for the preparation and fair presentation of these financial statements in accordance with accounting principles generally accepted in the United States of America; this includes the design, j; implementation, and maintenance of internal control relevant to the preparation and fair presentation of financial statements that are free from material misstatement whether due to fraud or error. Accountant's Responsibility My 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 me to perform procedures to obtain limited assurance as a basis for reporting whether I am 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. I believe that the results of my procedures provide a reasonable basis for my conclusion. Accountant's Conclusion Based on my review, I am 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. Supplementary Information The supplementary information Included in Schedules I and II is presented for purposes of additional analysis and f is not a required part of the basic financial statements. The information is the representation of management. I have reviewed the information and, based on my review, I am not aware of any material modifications that should be made to the information in order for it to be in accordance with accounting principles generally accepted in the United States of America. I have not audited the information and, accordingly, do not express an opinion on such information. Anthony P. Dley, CPA, P.C. Elkhart, Indiana February 24, 2022 When the prospective Contractor is unable to certify to any of the statements below, it shall attach as explanation to this Affidavit CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION REGARDING INVESTMENT WITH III^ 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 .L N1I)II MA ) ) SS: EucKgtzr 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 or 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. Contactor certifies by submission of this proposal that neither contractor nor any of its principals are presently debarred, suspended, proposed fm 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, "han" means the govermnent of Iran and any agency or instrumentality of han, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from time -to -time. b. As provided by Ind. Code § 5-22-16.5-5, as amended from time -to -time, a Contractor is engaged in investment activities in Iran if either: i. Contactor, its successor or its affiliate, provides goods or services of twenty million dollars ($20,OOQ,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. Cmrtactor does not larowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the Contractor subsequently ]earns is an unauthorized alien. Version 09/291202I Contractor's Bid for 0ublic Works - 4 Contractor agrees that be/she/it shatt 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 m contract with an unauthorized alien, nor retain airy 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 contractwith the City of South Bend, and understands that the City may terminate the contract for default if the Contractor fails to cure a breach of this provision no later than thirty (30) days after being notified by the City. 6. Persons, firms, partnerships, corporations, associations, orjoint venturers awarded a contract by the City of South Bend through its agencies, boards, or commissions shall not discriminate against any employee or applicant for employment in the performance of a City contract with respect to 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, Tabor, 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 tither meet both MBE and WBE utilization goals or demonstrate that the Contractor has made good faith efforts to obtain participation from MBE and WBE subcontmctms. A finding of noncompliance or a discriminatory practice shall prohibit that Contractor from being awarded it 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 m 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 orany of its agencies, boards or commissions. Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the performance of this contract with privileges of employment, or any matter directly or indirectly related to employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation, handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of contract. I, the undersigned bidder or agent as contractor on a public works project, understand my statutory obligations to the use of steel products or foundry products made in theUnited 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 winks, shall make a determination if the price of United States made steel or foundry is unreasonable. I understand that violations hereunder Version 09/29/2021 Contractor's Bid for Public Works - 5 may result in forfeiture of contractual payments. I hereby af5rm under the penalties of perjury that the facts and information contained in the foregoing bid for public works are true and correct. Dated this Q+h day of JkflQIL 20L�3 eMIUMCOMCKyescKJICE 5 Ti c. Contractor/Bid (Firm) Sigliature of Contractor/Bidder or Its Agent f Y y CakEy .P. Printed Name and Title Subscribed and sworn to before me this try o 01 f I�P�IL 20 �3 My Commission Expires w aC1 C e OL YU./l_ N tary Public County of Residence LKRAKT JANEE M TOWNER NOTARY PUBLIC SEAL ELKHART COUNTY, STATE OF INDIANA COMMISSION EXPIRES FEBRUARY 12, 2026 COMMISSION NO, 710399 Version 09/29/2021 Contractor's Bid for Public Works - 6 BID/PROPOSAL CITY OF SOUTH BEND Project Name: 2023 Traffic Project Number: 122-014C For Bids Due: April 113 2023 Contractor Name: 9kE u�a Ga�JG C£�E '�E k aM65 DIVISION 1 Item Description Quantity Unit Unit Price Total Amount No. 1 Concrete Speed Hump 12 EA i'8 4� 4" 2 Installation Rubber Speed Table 2 EA ( 566 j22� 4 oco 3 Installation Roadway Signs 28 EA 4 High Contrast Chevron Pavement 24 EA co os Marking Set 5 High Contrast Advanced Warning EA ob 06 Striping 28 � DIVISION 1 TOTAL o7�7 38d � ALTERNATE DIVISION 1 Item Description Quantity Unit Unit Price Total Amount No. 6 Restriping Chevron Set 24 EA 1250 00 3D ao High Contrast Advanced Warning EA s(�} 0 /� 15 Striping28 ALTERNATE DIVISION 1 TOTAL yV D� Version 09/29/2021 Contractor's Bid for Public Works - 7 BID/PROPOSAL CITY OF SOUTH BEND Project Name: 2023 Traffic Calming Project Number: 122-014C For Bids Due: April 11, 2023 GontractorName: 17UEOWUAI Cd,JGR,CrA: Oki4r AE5 DIVISION 2 Item Description Quantity Unit Unit Price Total Amount No, 1 Concrete Speed Hump 15 EA 78 %) `" ,Zg4; 2 High Contrast Chevron Pavement 30 EA04 �� ob 33 GGD Markin Set 3 Installation Roadway Signs 30 EA 4 High Contrast Advanced Warning EA cd �3 oO Stri in 30 DIVISION 2 TOTAL 3.3 � 00 ALTERNATE DIVISION 2 Item Description Quantity Unit Unit Price Total Amount No. 5 Restriping Chevron Set 8 EA 11250 6 High Contrast Advanced Warning 16 EA 5o�j= 8� pea Stri in ALTERNATE DIVISION 2 TOTAL F Version 09/29/2021 Contractor's Bid for Public Works - 8 BID/PROPOSAL CITY OF SOUTH BEND Project Name: 2023 Traffic Calming Project Number: For Bids Due: 122-014C April 11, 2023 Contractor Name: 40A)6ALTE. ,SRR Sktc 5 DIVISION 3 Item Description Quantity Unit Unit Price Total Amount No. 1 Concrete Speed Hump 13 EA 18 iSb aZ`%(o jSD 00 2 Installation Rubber Speed Table 3 EA a� 6Fj spy m 3 Installation Roadway Signs 32 EA 4 High Contrast Chevron Pavement 26 EA 4 a$ 6Aa Marking Set 1160 5 High Contrast Advanced Warning 32 EA oO cO Striping DIVISION 3 TOTAL ALTERNATE DIVISION 3 Item Description Quantity Unit Unit Price Total Amount No. 6 Restriping Chevron Set 10 EA 7 Sigh Contrast Advanced Warning 14 EA � Soo tri in ALTERNATE DIVISION 3 TOTAL �%,SGO ec� Version 09/29/2021 Contractor's Bid for Public Works - 9 BID/PROPOSAL CITY OF SOUTH BEND Project Name: 2023 Traffic Calming Project Number: For Bids Due: 122-014C April 11, 2023 ContractorName: 5E.?0-Z'C-4E5 DIVISION 4 Item No. Description Quantity Unit Unit Price Total Amount 1 Concrete Speed Hump 12 EA 2 Installation Rubber Speed Table 5 EA (P Sc;D 3� Sm 3 Installation Roadway Signs 34 EA %gS� 4 High Contrast Chevron Pavement 24 EA `n �i /,go 00 Markin Set 5 High Contrast Advanced Warning EA o� y� m / _ Striping 34 1 DIVISION 4 TOTAL ALTERNATE DIVISION 4 Item Description Quantity Unit Unit Price Total Amount No. 6 Restriping Chevron Set 30 EA 3% S� �'— y High Contrast Advanced Warning 34 EA do°0 SbD �7Q� Stri in ALTERNATE DIVISION 4 TOTAL J °I. S� Version 09/29/2021 Contractor's Bid for Public Works - 10 BID/PROPOSAL CITY OF SOUTH BEND Project Name: 2023 Traffic Calming Project Number: 122-014C For Bids Due: April 11, 2023 ContractorName: mgmx"w/ & aArA DIVISION 5 Item Description Quantity Unit Unit Price Total Amount No. 1 Concrete Speed Hump 12 EA ele R 90 �2? y(y} 2 Installation Rubber Speed Table 4 EA S� .ZG D� "6 3 Installation Roadway Signs 32 EA a5> /,7p d' 4 High Contrast Chevron Pavement 24 EA .� % /oo %id, ya' Markin Set 5 High Contrast Advanced Warning EA y� Striping 32 DIVISION 5 TOTAL 3LI1 ALTERNATE DIVISION 5 Item Description Quantity Unit Unit Price Total Amount No. High Contrast Advanced Warning 4 EA 6 Stri in ALTERNATE DIVISION 5 TOTAL Version 09/29/2021 Contractors Bid for Public Works - 11 BID/PROPOSAL CITY OF SOUTH BEND Project Name: 2023 Traffic Calming Project Number: 122-014C For Bids Due: April 11, 2023 ContractorName: rArzf;2 "0? CO�rJG.CETE fk Q111GES DIVISION 6 Item Description Quantity Unit Unit Price Total Amount No. 1 Concrete Speed Hump 10 EA $ gf�j l 52:0 2 Installation Rubber Speed Table 6 EA 3r( OGY� 3 Installation Roadway Signs 32 EA 4 High Contrast Chevron Pavement 20 EA o > po co 2;?140Q, Markin Set 5 High Contrast Advanced Warning EA ysD Striping32 DIVISION 6 TOTAL ALTERNATE DIVISION 6 Item Description Quantity Unit Unit Price Total Amount No, 6 Restriping Chevron Set 8 EA �/ 2 j0 /to, ab Q' y High Contrast Advanced Warning 14 EA �� 7at� Stri in ALTERNATE DIVISION 6 TOTAL 4�O�' Bidder (Firm): PRF..�nluA+ �dtilG+fETE ,SERyiGE � Address: %IA %jS'c#0410A40 37 City/State/Zip: ELkIMA+SA7 Y4,,s/(p Telephone Number: ($7y) By (Signature) 0o t K1 (Printed Name of Person Signing) Version 09/29/2021 Contractor's Bid for Public Works - 12 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: 122-014C Project Name: 2023 Traffic Calming OD Bidder: PRE»rtunr CaVSR67E 5AEtV1GE5 Total Bid Amount: MBE Goal: 0.03% Page_.L.of fo DIVISION 1 BID AMOUNT 331 p 380 Name &Address of MBE Primary Contact Person (Name/Telephone) Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of MBE Component Percentage of Total Bid/Proposal 117C4465 L6625Tx45 zal3 5TCNa4r.¢g AvE 6FRNA00 C,oUTEL UGI�A C� co 5ot~-rµ bEua, xa �/(�iy 57y) 943-do7/ 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-1.0 MBE UTILIZATION PLAN DIVISION 2 BID AMOUNT �35 30` Name &Address of MBE Primary Contact Person (Name/Telephone) Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of MBE Component Percentage of Total Bid/Proposal r u- cch55 L06251Ze6 22 13 5r c#**tLw1 3 AOE 5xarhf ,f, AA0*;XW V66 iy Zw9kAJ Fj(p Ca wrrAE Cs?Y) 993,E-7r TRuCKTs j Version 09/29/2021 Contractor's Bid for Public Works -14 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE-1.0 MBE UTILIZATION PLAN DIVISION 3 BID AMOUNT . llz� Name &Address of MBE Primary Contact Person Primary Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of MBE Component Percentage of Total Bid/Proposal /"rC4F55 406F57-TcS A;z15 ST c#*RL*E5 Au6 5wdio B4C O XAJ 1166111 BtRN"*.D cowrzz 57y� T9 3 4071 1'4"CkrA)6 0• I Version 09/29l2021 Contractor's Bid for Public Works - 15 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE-1.0 MBE UTILIZATION PLAN DIVISION 4 BID AMOUNT i V Name &Address of MBE Primary Contact Person (Name/Telephone) Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of MBE Component Percentage of Total Bid/Proposal GLASS L�6=srrr5 az 13 sr C#4ALE5^)C sours 3E,�o, sn� y6Giy bEAIVARO cou-rEk (S?y� 993-cn-zl Ru�E2.JC� o a / / Zo Version 09/29/2021 Contractor's Bid for Public Works - 16 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE-1.0 MBE UTILIZATION PLAN 03O5 3Xs= DIVISION 5 BID AMOUNT 40 Name &Address of MBE Primary Contact Person (Name/Telephone) Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of MBE Component Percentage of Total Bid/Proposal t 5f GLASS L0675�GS ,22 /3 5% GNARLES AJE $ourH 9;F,uD, Sn% elcov Gvu-rEE 574) 51� 3 0071 yC� D,13�0 Version 09/29l2021 Contractor's Bid for Public Works - 17 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBEA,0 MBE UTILIZATION PLAN DIVISION 6 BID AMOUNT*°Zq� 026 Name &Address of MBE Primary Contact Person (Name/Telephone) Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of MBE Component Percentage of Total Bid/Proposal f � GL/F55 Ld(,zsTuS ;U 13 sr c#,aA Avg Smrr* V",0 sa 4&6l B£R,t)RRD 7999 3 -0071 od Submitted by: �x 7f*f 7 ' , ( G / PO Z 1 Print Name Si ature Date Version 09/29/2021 Contractor's Bid for Public Works - 18 c�u�t�ds^\ CITY OF SOUTH BEND �� MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM WBE-1.0 WBE UTILIZATION PLAN This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving WBE participation. It is the bidder's sole responsibility to verify whether any listed woman -owned business meets the WBE qualifications. Project Number: 122-014C Project Name: 2023 Traffic Calming Bidder: PR[wfSTUM 60A)CA TtL S,C�40X6{.STotal Bid Amount: ��,9r�,0?60 WBE Goal: 0.09% DIVISION 1 BID AMOUNT�331� 39� Page of Name &Address of WBE Primary Contact Person (Name/Telephone) Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of WBE Component Percentage of Total Bid/Proposal ST/F'f� BAR9;r4AO2wn16 0?g9(03 6(5;45� WdEs7� SourN QE,UD�,JW N(a6028 77AnCS M=J!015KZ 57y 287-.707$ STG� SNST/�GC14T�dtJ / �RkGFSL $�j / D��o Version 09/29/2021 Contractor's Bid for Public Works - 19 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM WBE-1.0 WBE UTILIZATION PLAN DIVISION 2 BID AMOUNT 35!�j�✓ Name 8 Address of WBE Primary Contact Person (Name/Telephone) Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of WBE Component Percentage of Total Bid/Proposal 57WE 64AAzu4OrA)G ;?qt?&3 Uga6 wEST 5 LC48G)D/x0i ij&628 3AArg5 Mrc#ALSKr. C.Szi)W87-oR078 SSGrt) 1ti5TALC / r RAFF� 9 a�i 735� a.OSFo Version 09/29/2021 Contractor's Bid for Public Works -20 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM WBE-1.0 WBE UTILIZATION PLAN DIVISION 3 BID AMOUNT 337/gb Name & Address of WBE Primary Contact Person (Name/Telephone) Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of WBE Component Percentage of Total Bid/Proposal STATE 130+AAS4440Y/ )& .2q963 US ; U /.JEST 60UT# nNAgI=0 Y6(oi8 "T!}atES MSCfFAGSYs 57y) ,�87_,zo�8 SZG v 7RRFF�� _ c2.3.2 go Version 09l29/2021 Contractors Bid for Public Works - 21 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM WBE-1.0 WBE UTILIZATION PLAN DIVISION 4 BID AMOUNT 365i7S0'� Name 6 Address of WBE Primary Contact Person (Name/Telephone) Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of WBE Component Percentage of Total Bid/Proposal 5T-#M 8AAXCAAL J& a4463 u5 Z> WEST �* � �,�a yb��g �X*40YE5 (57� 287-2078 MCA) r" Si�¢GL IQA-FF�L B y 33ao 2• a8�o Version 09/29/2021 Contractor's Bid for Public Works - 22 ocre CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM WBE-1.0 WBE UTILIZATION PLAN DIVISIONS BID AMOUNT � 3, Name &Address of WBE Primary Contact Person (NamefTelephone) Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of WBE Component Percentage of Total Bid/Proposal i'rA?E /3l�kR2CAorNG 20 w<sT SarrfF3EuD,sN �66�8 JR.nES rlktf�c sa.L s24�.?8�-.�o?g SZG J 1wJ5Ti¢[ L� %R4F�2L %,goo — 572 Version 09/29/2021 Contractor's Bid for Public Works - 23 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM WBE-1.0 WBE UTILIZATION PLAN DIVISION 6 BID AMOUNT 29(40)�D Name &Address of WBE Primary Contact Person (Namerrelephone) Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of WBE Component Percentage of Total Bid/Proposal 5rATC 8AARX44=*061 V 2ti9(o3 6(5 oa7 CJE5T 5cuTO &4n(SAJ y(0628 "T4^E5 MxC*)fLSCr. C) �G'J 1A15Ti�GL %8(�O %D%a Submitted by: `�/ /�� ���i> ZC Print Name Si ature Date / Version 09/29/2021 Contractor's Bid for Public Works - 24 4 I CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN/z FORM MBE-2.0 d,$ EVIDENCE OF GOOD FAITH EFFORTS This completed form should be included as part of the Bids documents related to City of South Bend Public Works Projects requiring Good Faith Efforts to obtain MBE participation. Project Number: 122-014C Date: Yl fi /;Z 3 Project Name: 2023 Bidder: % Contact Person: Address: QEro�k,�l CDN4lETE 5�R Jsce /QOlG L3r:GK Telephone: (�Zq�2G4/'ol9G .7 1z �N70i✓.� 5T City: ate Email: R fI�GkEk ii/REArrft,r7 L0 JG�E7e O.�LSw, COIry 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*: EVIDENCE OF GOOD FAITH EFFORTS MBE LIST(S): The bidder reviewed 1) the City of South Bend's Minority and Women Business Enterprise Inclusion Program Plan; 2) the list of certified MWBEs provided bythe City; and 3) the Indiana Department of Administration list of Minority and Women Owned Businesses (both certified and non -certified) found at: http://www.in.gov/ldoa/. 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 htt ://www.in. ov/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. I affirm that I have made good faith efforts to solicit through all reasonable and available mmeans 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 Mr 1" 1.' MBEs of contracting and subcontracting opportunities. I affirm that I advertised in general circulation and/or trade association publications concerning subcontract opportunities and allowed MBEs reasonable time to respond to such advertisements. I affirm that I performed any and all necessary steps to provide written notices in a manner reasonably calculated to inform MBEs of subcontracting opportunities and allowed sufficient time for MBEs to participate effectively. I affirm that I followed up on initial solicitations with interested MBEs. I affirm that I negotiated with interested MBEs in good faith, including providing such MBEs with adequate information about the plans, specifications and other requirements of the subcontract. 1 affirm that I have made good faith efforts to assist interested MBEs in obtaining bonding, T ` lines of credit, or insurance as required by the City or the bidder, where appropriate. Version 09/29/2021 Contractor's Bid for Public Works - 25 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE-2.0 EVIDENCE OF GOOD FAITH EFFORTS I affirm that I have made good faith efforts to assist interested MBEs in obtaining necessary equipment, supplies, materials, or related assistances or services, where appropriate. I affirm that I did not reject any MBEs as unqualified without sound business reasons based M 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 - 26 CITY OF SOUTH BEND 4 ii MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM WBE-2.0:ra lets EVIDENCE OF GOOD FAITH EFFORTS This completed form should be included as part of the Bids documents related to City of South Bend Public Works Projects requiring Good Faith Efforts to obtain MWBE participation. Project Number: 122-014C Date: Project Name: Bidder: Contact Person: Address: City: Email: Traffic Ro 3 take-lcE2 71 oZ R-�t{�+ta�D Si Et 9hwxr State: 2.y Zip: 11(vy6 @ tout eEre oaGr�4, co n R (3EckER YRF�rruo, To determine whether a bidder has demonstrated good faith efforts to reach the WBE utilization goals set forth in the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or commissions, REQUIRE ALL of the following Good Faith Efforts as listed in the table below`: 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: http://www.in.gov/idoa/, GOOD FAITH EFFORTS TO OBTAIN WBE PARTICIPATION The bidder shall initial each item below, as evidence of its good faith efforts to obtain WBE participation in the awarded contract. I affirm that I reviewed the City of South Bend's Minority and Women Business Enterprise Inclusion Program Plan and the Indiana Department of Administration's certified list of Indiana Minority and Women Business Enterprises, found on their website w htt ://ww.in. ov/idoa . I affirm that I have made good faith efforts to select portions of the contract work to be performed by WBEs, including, where appropriate, breaking out contract work items into economically feasible units to facilitate WBE participation. I affirm that I have made good faith efforts to solicit through all reasonable and available means the interest of all WBEs in the scopes of work of the contract, affirm that I attended all pre -bid meetings scheduled by the City of South Bend to inform WBEs of contracting and subcontracting opportunities. 1 affirm that I advertised in general circulation and/or trade association publications concerning subcontract opportunities and allowed WBEs reasonable time to respond to such advertisements. I affirm that I performed any and all necessary steps to provide written notices in a manner yf� reasonably calculated to inform WBEs of subcontracting opportunities and allowed N� sufficient time for WBEs to participate effectively. I affirm that I followed up on initial solicitations with interested WBEs. I affirm that I negotiated with interested WBEs in good faith, including providing such WBEs with adequate information about the plans, specifications and other requirements of the subcontract. I affirm that I have made good faith efforts to assist interested WBEs in obtaining bonding, m� lines of credit, or insurance as required by the City or the bidder, where appropriate. Version 09/29/2021 Contractor's Bid for Public Works - 27 uF'ca—fe Urto,. CITY OF SOUTH BEND 4 d� MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN zs 1 FORM WBE-2.0 � •. EVIDENCE OF GOOD FAITH EFFORTS I affirm that I have made good faith efforts to assist interested WBEs in obtaining necessary equipment, supplies, materials, or related assistances or services, where appropriate. 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 - 28 �uati nF . ;� YG CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN* FORM MBE-2.1 tau MBE CONTACTED This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring Good Faith Efforts to contact MBEs. It is the bidder's sole responsibility to verify whether any listed minority -owned business meets the MBE qualifications. Attach additional pages if necessary. PAGE_OF Project Number: 122-014C Project Name: 2023 Traffic Calming Biddy By: BE Firm st 455 f.06 :57T-c5 Owner or Contact at MBE Firm 134AA)AAD G Telephone: VN 9f3-067/ Fax: TYPE OF WORK SOLICITED FOR THIS PROJECT: MBE Participation Goal 0.03% )G1 Email: ��jT(a¢gSLt�bZSTiGS�d/3LGniA1L,Co�y RESULTS OF CONTACT WITH THE MBE FIRM: laxu_ Lt7'�t-zz£ �F RwaRo�p MBE Firm Owner or Contact at MBE Firm Telephone: Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBE FIRM: Version 09/29/2021 Contractor's Bid for Public Works - 29 / G CITY OF SOUTH BEND o MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN F At FORM MBE-2.1 WBE CONTACTED This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects rSquiring 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. PAGEOF.J� Project Number: 122-014C WBE Participation Goal 0.09% Project Name: 2023 Traffic Calming Bidder: " /(�nsu� CONGREYE By: arJ (Signature) (Title) WBE Firm �7/fT� �SAkWGAD.Zrt)G SNi G Owner or Contact at WBE Firm �J714+1ES /fiSGH'Hf.$k.Z Telephone:(57d) d$7 — ?D i$ Fax: TYPE OF WORK SOLICITED FOR THIS PROJECT Email: 5�RTEBARfZ2c�4or 27 �G.t1 .T..JST/4GL �- iRA-FF.� P.oA1TRaL RESULTS OF CONTACT WITH THE WBE FIRM: a7Z�L 14T X L ZE Z�: F Aj�04ROoffD WBE Firm -rgf," co Owner or Contact at WBE Firm A514LEY p:644R96t.5 Telephone: 57V 2z3' 5el7 Fax: Email: P6#L6'y 19 �¢2iQ�7llKks.00>,�d�t TYPE OF WORK SOLICITED FOR THIS PROJECT: 409MIEWr rgl4R)�1465 :5TkTZ 6 RESULTS OF CONTACT WITH THE WBE FIRM: IIII U`!'14�Zf�ZE zF gw4R40ED Version 09/29/2021 Contractor's Bid for Public Works - 30 1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND, INDIANA 46601-1830 PHONE 574/235-9251 FAx 574/235-9171 TDD 574/ 235-5567 CITY OF SOUTH BEND JAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS Date: March 23, 2023 To: All Planholders From Theresa Heffner, Clerk, Board of Public Works Subject Addendum Number: 1 Project Name: Project No.: 2023 `Traffic 122-014C ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: :3 /.Z8 % 23 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. The attached documents are hereby added to the Specifications and Contract Documents and become a part of herein. Company: '�RE/�7T.GLrv1/C_.Oit1C/ZF_'T� J�/Q UlC�'.S Authorized Signature: �✓( Date: 3/26 43 1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND, INDIANA 46601-1830 Date: To: From Subject PHONE 574/235-9251 FAx 574/ 235-9171 TDD 574/ 235-5567 CITY OF SOUTH BEND JAMES MUELLER5 MAYOR BOARD OF PUBLIC WORKS Apri15 2023 All Planholders Theresa Heffner, Clerk, Board of Public Works Addendum Number: 2 Project Name: 2023 Traffic Calming Project No.: 122-014C lat�KN®�IILEDG/E /MEl�'� Date Received: Y` 0 ! 23 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 A package upon submittal. Notes: The attached documents are hereby added to the Specifications and Contract Documents and become a part of herein. Company: Authorized Si Date: CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK RESPONSIBLE BIDDER CHECKLIST Project Name 2023 Traffic Calming Project No. 122.014C For Bids Due April 11, 2023 9:00 a.m., Local Time Contractor Name: %RCMs/,�ry Con1GRET& SERJsc65 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 31s' for the upcoming calendar year, or within twelve (12) months of obtaining pre - qualified standing. If the status of any item changes within the twelve (12) months, it is the responsibility of the contractor to notify the City. Failure by any pre -qualified contractor to submit its complete application for continuation of "pre -qualified" standing within the time prescribed above shall result in automatic removal of the designation, effective January 1 ofthe following year, or immediately following the twelve (12) months of pre -qualified standing. However, the "removed" contractor or subcontractor shall still be permitted to bid on City public works projects, though the contractor must submit all required documents under 6-63 until "pre -qualified" status is re-established. Please Note: The City reserves the right to request supplemental information from the bidder, additional verification of any information provided by the bidder, and may also conduct random inquiries of the bidder's current and previous customers regardless of pre•qualified standing. It is the sole responsibility of the potential bidder to comply with all submission requirements applicable to the bidder in Section 6-63 of the Responsible Bidding Ordinance no later than the date of the public bid opening. Version 02/23/2022 General Conditions - 10 POST BID SUBMISSIONS: Post -bid submissions must be submitted in accordance with Section 6-64 of the Responsible Bidding Ordinance. The post -bid submission requirements are as follows: 1. All bidders shall collect, maintain, and provide upon request, a current written list that discloses the name, address, licensing status, and type of work for any subcontractor from whom the bidder has accepted a bid and/or intends to hire on any part of the public work project, including individuals performing work as independent contractors. 2. Each subcontractor, whose portion of the project is estimated to be at least one -hundred fifty thousand dollars ($150,000.00), shall be required to adhere to the requirements of Section I of the Responsible Bidder Ordinance as though it were bidding directly to the City, except that the subcontractor shall submit the required information (including the name, address, and type of work) to the successful bidder prior to the commencement of work. 3. Failure of a subcontractor to submit the required information shall not disqualify the successful bidder from performing work on the project and shall not constitute a contractual default and/or breach by the successful bidder. However, the City may withhold all payment otherwise due for work performed by a subcontractor, until the subcontractor submits the required information and the City approves such information. 4. The disclosure of a subcontractor list ("Disclosed Subcontractors)") to the City by a bidder shall not create any rights in the Disclosed Subcontractor(s). Thus, a bidder may substitute another subcontractor for a Disclosed Subcontractor by giving the City, upon request, written notice of the name, address, licensing status, and type of work of the substitute subcontractor. 5. The successful bidder and all subcontractors on a public works project are required to submit certified payroll utilizing the federal form known as WH-347 or a similar form on a bi-weekly basis, submitted within 10 days after the end of each bi-weekly payroll period. Certified payrolls shall identify the job title and craft for each employee. Certified payrolls shall be submitted electronically. Please Note: Submissions deemed inadequate, incomplete, or untimely by the City may result in the automatic disqualification of the bid. The City, after review of complete and timely submissions, shall, in its sole discretion, after taking into account all information in the submission requirements, determine whether a bidder is responsive and esponsible, and provide a Pre -Qualification Verification Letter. The City specifically reserves the right to utilize all information provided in the contractor's submission and any information obtained by the City through its own independent verification of the information provided by the contractor. Version 02/23/2022 General Conditions - 11 PRE -QUALIFIED BIDDER CHECKLIST (a) Acknowledgements: (i) _ By checking this box, I hereby acknowledge that I am a pre -qualified bidder with the City of South Bend and that I have met the pre -qualification requirements within the last twelve (12) months. A copy of my Pre -Qualification verification letter is attached. (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) _ Indiana Secretary of State's on-line records (ie. Business verification) dated within sixty (60) days of the submission of said document showing that business is in existence, current with the Indiana Secretary of State's Business Entity Report, and eligible for a certificate of good standing. (Not applicable to individuals, sole proprietors or partnerships). (ii) _ Statement on staffing capabilities, including labor sources. This statement indicates and ensures I have sufficient employees on staff to complete the work. It outlines how I intend to meet the staffing needs of the work. (iii) _ List of projects of similar size and scope of work performed in all areas, including the State of Indiana, within the last three (3) years. (iv) _ For every project, submit evidence of participation in apprenticeship and training programs, applicable to the work to be performed on the project, which are approved by and registered with the United States Department of Labor's Office of Apprenticeship, or its successor organization. Version 02/23/2022 General Conditions - 12 11, PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED) (a) Acknowledgements: (i) ✓ By checking this box, I hereby acknowledge that I am not a pre -qualified bidder With the City of South Bend. 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. By checking this box, I hereby acknowledge that copies of all Applicable apprenticeship certificates or standards for training programs applicable to the work performed on the project may be requested at any time and shall be furnished / upon request. (iv) ✓ By checking this box, I hereby acknowledge and ensure that I and all sub- contractors, from whom I have accepted a bid and/or intend to hire to perform work on the public work project, are properly licensed. Furthermore, I acknowledge my understanding that it is my responsibility to ensure that all sub -contractors have the necessary licenses to undertake the work called for in this bid. If a sub- contractor loses their license at any point, it is the responsibility of that sub- contractor to notify the City. (b) Attachments: (i) ✓ 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) 0101 List identifying all former business names. (III) 11 h Any determinations by a court or governmental agency any violations of federal state, or local laws including, but not limited to, violations of contracting or antitrust laws, tax or licensing laws, environmental laws, Occupational Safety and Health Act (OSHA), or federal Davis -Bacon and related Acts, within the preceding five (5) years. (iv) Statement about staffing capabilities, including labor sources. This statement indicates and ensures I have sufficient employees on staff to complete the work I am bidding on OR outlines how I intend to meet the staffing needs of the work. (v) ✓ Statement that individuals who will perform work on the public work project on my behalf will be properly classified as an employee or as an independent contractor under all applicable state and federal laws and local ordinances. (vi) For every project, submit evidence of participation in apprenticeship and training programs, applicable to the work to be performed on the project, which are approved by and registered with the United States Department of Labor's Office of Apprenticeship, or its successor organization. (vii) _ Copy of a written plan for employee drug testing that covers all of my employees who will perform work on the public work project and meets or exceeds the / requirements set forth in IC 4-13-18-5 or IC 4-13-18-6, (viii) J Evidence that I am utilizing a surety company which is on the Bureau of Fiscal Service "Department of Treasury's Listing of Approved Sureties' as required in the bid specifications or contract. Version 02/23/2022 General Conditions - 13 (ix) r� Written statement of any federal, state or local tax liens or tax delinquencies owed to any federal, state or local taxing body in the preceding three years. (i) List of projects of similar size and scope of work performed in all areas, including the State of Indiana, within three (3) years prior to the date on which the bid is due. Date: 71 " 14K (Sign Her (Print Name Here) PR 1sun COAX ErE 5''Rvzc.E3 (Name of Company) -21 ;� 5T (Address of Company) ELk uAk1- (aty) TnJ (State) (Telephone Number) Version 02/23/2022 General Conditions - 14 State of Indiana Office of the Secretary of State CERTIFICATE Or EXI5i'ENCE To Whom'fhese Presents Come, Greetings I, HOLLI SULLIVAN, Secretary of State of Indiana, do hereby certify that I am, by virtue of the laws of the State of Indiana, the custodian of the corporate records and the proper official to execute this certificate. PREMIUM`CONC4t6A SERVICES, INC le duly filed the, requisite documents to cornrfi LLLALlaLsiness activities under the laws of the State of 1.Indiana on Noycmber 24, 2004, and was hi exis4epce oriauthor!Zed to transac'Itt b'0siness'.Iq;the State of Indiana on tViarch 01, 2022AL tLA AL. further certify this Domestic Por•Profit Corporation has filed Its most recent report required by Indiana law wlth the Secretary of State, or Is not yet.4equired to file such report, and that no notice of withdrawal dlssoiution or expiration has been {Iliad or taken pI�ce, All fees, taAs, interest, and penaltles owed to Indiana by the domestic or foreign entity and Sailected by the ecretary of State have been paid. In Witness Whereof, I have caused to be affixed my signature alnd)the seal of the State of Indiana, at the City of Indianapolis; March 01, 2022 I10LLI SULLIVAN SECRETARY OF STATE 20041.20100105/20222461045 All certificates should he validated here: https;J/bidsosdn.gov/ValldateCertificatc Expires on March 81, 2022. Premium Concrete Services, Inc 712 Richmond Street [Ikhart, IN 46516 574-264-0196 fax 574-266-5392 03/02/2022 To Whom it may concern, Premium Concrete Services, Inc, currently employs 27 people, 5 of which are field supervisors, 6 concrete finishers, 11 laborers and 4 heavy equipment operators. We are signatory to the local Cement Masons, Laborers and Operator's unions through which extra employees can be pulled from when needed, Max Yeal<ey VP Premium Concrete Services, Inc 712 Richmond Street Fllthart, IN 46516 574-264-0196 fax 574-266-5392 03/02/2022 To Whom it may concern, Premium Concrete Services, Inc, has all employees properly classified under all applicable state and federal laws and local ordinances, as well as any independent contractors that would potentially be called upon to assist in completing a job. Max Yeal<ey VP '1'o Whom Il May Concern; Phis is a ietter to inform you that Premium Concrete Services, Inc„ is a contractor member of the Building &. ConSU•netlpll Resource Center Ina (BCRC) drug testing program. 'They are a a01111•ibuting client and ITICC( all file industry standards set by t11e Business Roundtable of Northwest Indiana, the Substance Abuse & Mental Health Services Association, :and the Drug & Alcohol Testing Industry Association, and the Department of Transportation, Please be aCIVISCd tltat PI'enllllnl CottCi'CtC Sel'VICC9, Inc, located at 712 Richmond St, [Ikharl, IN 46516 is it participating employer in good standing with BCRC, All of Premium Concrete Services, luc.'s Employees are su�jeel to tine terms of the BCRC Drug Testing Policy, which meets or exceeds the requirements of IC 4-13-18-5 or IC 4.13-18-6. Please direct any questions regarding this correspondence h1 me, Sincerely, Leticia Roacll )✓xecutive Director I3CRC Adulinistt•alor, 1110. 219.764-1488 Pr<Itnolinr.� the Safely r ncl Well-13EIIngI of 6rnploY4ct , In Ihc1 W4rhpincct Nuifrliltg �CnnsbmJinn ItesnureeC'etd¢r, Fnn. Phollc: (279)704-.9>OQ � F'n.a: (2'l9) 764.95f15 6050 Southport Rand, tiuile 13 > I orlage, humnin 46.165 Deulntn.Dcreucicnru �L %< Old Ropublic Surety Company RO Box 1636 Milwaukee, WI 53201.1635 CONTINUATION CFR`I'IFICAX'I; no)mRuamun omnn W750104719 Building Contractor 5,000.00 09/1212U21 09/12/2022 PRINCIPAL Premium Concrete Sarvices, Inc 712 RICHMOND STREET ELI(HART, IN 46516 'ITlT rr_rr South Bend-SlJoseph County 125 S Lafayette Ste 100 South Bend, IN.46R01 ORlG1NAL FOR RAND RENEWAL THIS BOND C(1N'i'INUES IN F'OIlCE TO'nIE AEOVF EXPIRATION DATE CONUI'1'fONED AND PROVIllED'fHATTHELQSSES OR R1sCOVENCS ON IT AND ANY AND ALL ENDORSEMENTS SHALL NF.VBR EXCEL•D THE PHNAUTY SETFORTH 1N THE BOND AND WHETHER 773E LOSSES OR RECOVERIES ARE WITHIN THB FIRST AND(ORSUDSEQUENT OR WITHRIANY P.XTENSION OR RENEWAL PEIUOD, PRESENT, PASTOR FUT'UIUi. ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANOED. SIGNED ANA AATL'D'I'fllS 9lh DAY OP June 2021 0465314 GIBSON INSURANCE AGENCY, INC. Old Republic_ Surety Company 202 SOUTH MICHIGAN ST STE 1400 sunurY � po 6 h , 14,tg�wtt scAFa , >:b is ' � it SOUTH BEND, IN 46601 ATTORNf•,YEVPACT 574-245-3500 oRSCPiO)f (8f 1) *** OLD RE. I. JBLIC POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: Tile( OLD REPUBLIC SURETY COMPANY, a Wsconsin stock Insurance corporation, does make, constitute and appoint: Elise Faust of Brookfield, WI Its true and lawful Aftorney(s)-in-Facl, with full power and authority, not exceeding $10,000,000, fm• and on behalf of the company as swely, to execute and deliver and affix (he seal of (he company ihorato (if a seat is required). bonds, undertakings, recognizances or other written obligailons in Ilia nature thereof, (other that? hail bonds, henlr depository bonds, ntortryage deficiency honds, mortgage guaranty fronds, guarantees of lustrigment paper and note guaranty bonds, seifinsurance workers compensation bonds guarnnteeing payment of benefits, asbestos abatement contract bonds, wasfo management bonds, hazardous waste remediation hands or black Imlg bonds), as follows: Eff ectivo Dato: 911212021 12;00:00 AM Bond Number: W150104719 Bond Amount; Five Thousand Dollars $5,000,00 Principal Name: Promlum Concrete Services, Inc Obligee Namo: South Bend -St Joseph County of South Bend, IN and to bind OLD REPUBLIC SURETY COMPANY thereby, and all of the acts of said Atiorney.An-Fact, pursuant to These presents, are ratified and confirmed, 'Phis appointment Is made under and by authority of the board or directors at a special meeting held on February 18, 1982, This Power of Attorney Is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the board of directors of the OLD REPUBLIC SURETY COMPANY on February 19,1982. RESOLVED that the president, any vice president of assistant vice president, In conjunction with the secretary or any assistant secretary, may agpolnt attorneys -in -fact or agents with authority as donned or limited In the Instrument evidencing the appointment in each case, for and on behalf of the company to execute and deliver and affix the seal of the company to bonds, undertakings, recognizances, and suretyship obligations of all kinds; and sold officers may remove any such attorneydn-fact or agent and revoke any Power of Allomey previously granted to such parson. RESOLVED FURTHER that any bond, undertaking, recognizance, or suretyship obligation shall be valid and binding upon the Company (1) when signed by the president, any vice president or assistant vice president, and attested and sealed (if a seat be required) by any secretary or assistant secretary; or (II) when signed by the president, any vice president or assistant vice president, secretary or assistant secretary, and countersigned and sealed (it a seal be required) by a duly authorized attorney -in -fact or agent; or (lip when duly executed and sealed (If a seal be required) by one or more nutorneys-In-fact or agents pursuant to and within the limits of Ilia authority evidenced by the Power of Attorney Issued by the company to such person or persons. RESOLVED FURTHER that Ilse signature of any authorized officer and the seal of the company may be affixed by facsimile (o any Power of Allomey or certification thereof authorizing the execution and dellvery of any bond, undertaking, recognizance, or other suretyship obligation of ilia company; and such signature and seat when so used shall have the same force and effect as though manually affixed, IN WITNESS WHEREOF, OLD REPUBLIC SURETY COMPANY has caused these presents to be signed by Its proper officer, and Its corporate seal to be affixed this gill day of June 2021 ooj "apgF `..,ye OLD REPUBLIC SURETY COMPANY L Assistant o� e metal President mmn...arm mnn STATE OF WISCONSIN, COUNTY OF WAUItFSHA-SS On IBIS _ gilt -day of June 2021 , personally came before me, Alan Pavllc and Karen J. Haffner- to mo known to be the individuals and officers of (he OLD REPUBLIC SURETY COMPANY who executed the above instrument, and they each acknowledged the execullon of tiro some, and being by me duly sworn, did severally depose and say: that they are file said officers of (he corporation aforesaid, and that the seal affixed to Ilia above Instrument Is the seal of the corporallon, and that sold corporate seal and their signatures as such officers were duly affixed and subscribed to the said Instrument by the authority of the board of directors of said corporation. aril.$ y tp plant' bry •,. •'r Nolary Poblla My Conuniasion Expires: 09/25/2022 CERTIFICATE (Expiration of notary's ronuuission dnex fiat invalidate This InsirumeuQ I, Ilia undersigned, assistant secretary of the OLD REPUBLIC SURETY COMPANY, a Wisconsin corporation, CERTIFY that tiro foregohlg and attached Power, of Attorney iemalhs lit full force and has not been revoked; and furthermore, that the Resolutions of the board of directors set forth in the Power of Attorney, are now in force. ' 0455114 tt Asa a 5$A'L Signed and seated at the City of Brookfield, WI this gilt day of Juno 7021 ba� 4 . -- Ouse 222a2(aosl "" ^" pa:loam soototary GIBSON INSURANCE AGENCY, INC, INDXANA LABOZtEPY TRAINING TRUSTT FUND ilavtrlAI Frye Secretary -'Treasurer Any.1,, Uolk Chris L. Guerrero Ricky Henson, ,h,. Ratnon Mendoza, J+'. Damiy L. Sfalts 7a40. Box 758 - TTeQfard, Tndlana 4742r (812)279-9751 I7ebraazy 23, 2021 To Whom It May Concern: Sean Coakley, Uireomr John P. Brow Chairman Ifelly Abal A4lchad Fort ara Stan Meyer Mck Thnniuman Jhn Nsen+rrn i+AX: (II12) 279-S5A.5 ('oil l:ree (800) MAW This lottor is to confirm that "Pramium Concrete Services, Inc." is a signatory contactor in good standing with the Indiana Laborers'Training Trust Fund. The abovementioned company is a participant in the Joint Apprenticeship and Training Committee through this Union and has been an active participant in good standing for each of the past five plus consecutive years and is currently eligible to use our apprentices on a project. Further, our orgarvzation's program is approved by the U,S, Veterans Administration to participate in the QI educational benefits program. A copy of our approval letters are attached along with the collective bargaining agreement stating the ratios of Journey workers to Apprentices; which is one (1) Apprentice for every four (4) Journey workers and thereafter may not employ more that (1) Apprentice for every (3) Journey workers. Sificerely,, Seim Coakley, Director SC:jt www, indianalahorersh•arning,org au � _ _ ` m :_ TANA 1=430REV S TRASIRTTMIG TRUST FUND BEOFmmD DMT.AN2 for the trade classification of CONSTRUCTION CRAFT 1A9BORER eyisfereof as parf of iA �afional �pprer_fice.YAO J�rotyraam in accord Ence wife Z6e oasic sfa CEros of apprezzficesfiY,P esfa�1,s,6eof 6r fle r3ecrefarrf of Laar aecenber 1=t, 1�95 !N040-0528 STATE IN RNA DEPARTMENT OF VETERANS AFFAIRS STATE APPROVING AGENCY 402M W 46J IN IANAPOLIS, INDIANA A6`20427 a Jeremy Brewer Ai�.1>reritideshili Cooidiiator (iicliana S ab�xerS Training ust Fund-Apprenticoship 439 Patton Hill Rd. Bedford, IN 47421 llear Jeremy Brewer, Grictlolcamb,0overnor ___ James M. Drown, Qll'ector 7amiary 9, 2019 This will aclaxowledge receipt of your z evts od W ork Proe df r for the ao The'Sta ten Craft Laborer program offered at Hoosier Energy, tocated in Bedford, Indiana. The State Approv ng Agency has reviewed the document as listed below: FI2 TIXLC,PROGRAM XENGTl DOTCODJC Consiructiorx Craft LaUorex 4,0004800 hours 47-2061.00 FACI7 jyv CODE: 30004114 To the UesC of my knowledge Indiana Laborers Training Trust Puud-Apprenticoship does not utilize erroneous or misleading advertisement, either by aetual statement, omission, or uitimation. Tt is anderstood by Indiana Laborers 'Training Trust Exwd-Apprenticeship that they will maintain a complete record'of all advertising utilized by or on behalf of file company in regards to thou' Ixammg programs during the preceding 12 months. T he company's advertising will be available for review by any and all futate supervisory visits by the SAA, or the I7.S• Department of Veteran Affa rs. 'i'his approval is made pursuant to and raider the,provisions of Title 38, U. S. Code 3687, with an effective date of January a, 2019, If you :have any questions, please contact me at 3107-232-3916, Ir Sincerely, 'Tanigna Griffin Prop am llhectar Statc Approving Agency Co:VA.RMILR Phone, (3l7)-234G0G2 Totl Preo (600)-400-4520 Rax (917)-2344744 T TE F �N1 N DEPARTMENT OP VETERANS AHAIRS STATE APPROVING AGENCY 402 WEST WASHINOTON STREET ROOM W-469 INDIANAPOF IS, INDIANA 4020Q738 Trremy Brower Apprenticesbip Coordinator Indiana Laborers Training Trust Fund••Appreuticeship 439 Patton 13111 Rd. Bedford, IN 47421 Dear .Taremy Brewer, l=dcHolcomb,:Govemor �_ James M. Brown, Director Talmary 9, 2019 Tlie Indiana State Approving Agency conducted a supozvisory visit on 01/8%1019 at Indiana Laborers Training Trust Fund -Apprenticeship, The purpose of the visit was to provide traning to the Certifying Officials and review enrollment certifications, record retention and reporting procedures, The organization demonstrated proper record maintenance and record maintenance and reporting procedures; During the visit, we discussed the importance of reporting hours on a monthly basis, good record keeping techniques, and how to report a leave of absence or completion via VA Form 22.1999b. We also updated the Certifying Officials via VA. Form 22-8794, work processes, and wage scale. If you need any assistance or have any questions regarding this technical visit please contact me du'ecthy at tgriffin@a dva.iu.gov or (317) 232 3916. Thanlr. you for the courtesy extended during my visit, The education and training opportunities that your organization continues to provide veterans and their dependents are appreciated. Shicerely, Tajiiqua'Grifful Progr'ani Director Phony (317)-234-bD62 'roll Free (R00)-A00-4520 Pnx (317)-z34.8744 �0 PFF I Ep A7MFNT OVETERANBm AFFAIRS STATE APRUVIU AENCY elk � Q 402 WEST ASH NGTTON 3 FGT ROOM W469 INDIANAPOIIS, INDIANA46204.2736 Jeremy k3rewer Apprenticeship Coordinatox Indiana Laborers Training Tt'ust Ftmd•Apprenticosktip 4.39 Patton. Hill Rd, Bedford, IN 47421 Eric Holcomb, Goyerror James M. Brown, Director�� Janua y 9, 2019 Dear' Jeremy Ilrou�ex, This will acknowledge receipt of yours updated WagwScale for tho Construction Craft Taborer program offered by Indiana Laborers Training Trust I'und-Apprenticeslup. The State Approving Agency has reviewed the document as listed below: Wage Scale: Conatraction CrafC Taborer FACI][,ITX COA};'; 30004114 .Co tlxe 1ic�st of nny lutoWledge 7ncliiga Labbtors Tx0lning'1>;1rst I'tnxd Apprenticeship does not ytilt�o exroneQits or Yntsleadiizg advezdscracut eittiez by actual slatenncnt, omission of inipvtatton, It is tmderstood by Ir diaur Laborers Train ng Trust k`und-Apprenticeship that they will maintain a complete xecord of all advertising utilized by or on behalf of the Indiana laborers Training Trust Fund -Apprenticeship in regards to thou training programs during the preceding 12 mouths. Indiana Laborers Txammg Trust Fund-Appxenticesiip`s adve,rfisitlg will be available fox review by any and all £ufiro supervisory, visits by the SAA, or the U.S. Depailtnent of. Veteran Affairs, Please Reviow the entire packet for content and accutacy. Approval is granted pursuaut to the provisions of Title 38, U.S. Code 3687, with an effective date of April 1., 2018. If you have any questions, Please fool free, to give me a call at 317-232-3 916 or email me at tgriffin u @dva.in,gov.'I'halc you for 4vhat you do for oux Veterans, and have a great day! Srucerel.y, Tanigna Griffin Pro am Director State Approving Agency Cc: VARO/ELR V4',~� :/°4 %t NA 9 0 /018 STA)rAAnno�NG Aek„.,. Apprentice Status Report By Indenture ILPM Apprentices Indentured Between 1/1/2020 And 12131/2020 Apprentice Program: IN2 Year Apprentice Skates ApprenQices Percentage Print©d; T.uasday, JeOunry 7;:5021 '�� Apprentice Status Report By Indenture Date Apprentices Indentured Between 1f1/2017 And 5113/2020 Apprentice Program: IN2 Year APPreritice StatusW Approrltices Percentage 2017 Apprentice States Report By Indenturo Efate AppYenitcaa Indonture(j notwban 1/1/2017 And 8/13)2070 ApprenllcA Program; I142 Yeah _ FlpprOntiCe Status Apprentices Percentago 2019 Prinlad: ednosdny, May 13,2U2U NCaetare10 Cement Masons' Apprentlooahip Coordinator Loaal Union 1/692 To Whom it IVlay Concern: Phone: (219) 707-7767 mail; bkristoff@ploiniooal692.org I=ebruary 26, 202J. This letter is to certify that Premium Concrete Services Inc. is and has been a signatory contractor with CPCMIA Local 692 and has participated in the Plasterers & Cement Masons Apprenticeship Tralning Program for many years. Premium Concrete Services Innis a valued Contractor in good standing with Local 692 and the JATC. All our apprentices are registered with the United States Department of Labor•. I maybe reached at (?..19) 707-7767 if additional information is needed. Further, our organization's program is approved by the U,S, Veterans Administration to participate in the GI Education Benefit Program. Thank you, Arian Kristoff Apprentice Coordinator Plasterers & Cement Masons 9200 Louisiana 6troo4 Morriliville, Indiana �46�F10 11UVI/VIl.�'I_CML��AL.6oJ2.C,�t��a „,. AL Ir -F •�s ,, Pc "�":4rt"W _..q^�. `tj„ ;ro.±�`_.,. �It i\-�- 4-;..,,�:� iJ f="g?rf`z L.'��.4.��"`�,�'v :.7�?'- ��v� S%G- �a _ E �, �, - - ��-� rr s,.:J. Y R^.1�• o- `.fi r'+=a s =0R T �E TRADE C.-RSoi=€C.4TSOFifi: Cc!sl�Rr ti7ASC3�L P:�.ST= Premium Concrete Services, Inc 712 Richmond Street Elkhart, IN 46516 574-264-01.96 fax 574-266-5392 03/02/2022 To whom it may concern, Premium Concrete Services, Inc, has no federal, state or local tax delinquencies owed to any of the fore mentioned taxing bodies, nor has owed any in the past three years. Max Yeal<ey VP