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HomeMy WebLinkAboutOpening of Quotes - Century Center Parking Lot Seal and Stripe Proj No. 122-060B - National Pavement Maintenance/yu CITY OF SOUTH BEND, INDIANA; CONTRACTOR'S QUOTE FOR PUBLIC WORK PROJECT NAME: Century Center Parking Lot Seal and Stripe PROJECT NO. 122-060B QUOTES DUE April 111h, 2023 at 9.00am EST to bpwbidsCDsouthbendin.gov Date: Address: City/State/Zip (Must be completed for all quotes. Please type or print) I Firm: %y �®�' ✓111L�V E Ind E 1� ��,1f 1� e�iVYC C�1Vtk P6EU 4JE I'i� ANV� i`- its ((i4 Telephone Number: (.370) Z66 -G 38a 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: the City of South Bend, Indiana, in accordance with plans and specifications prepared by: The City of South Bend, Department of Public Works and dated Q� a� 3 for the sum of (enter the Total Quote as shown on the Proposal) ..I I JSt Sum of Total Quote plus Alternates shown on Proposal) (Numerical) If alternative quotes 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 quote is to be awarded on a unit basis, the itemization of the units shall be shown on a separate attachment. The above quote is accepted this Subject to the following conditions: BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Gary A. Gilot, Member Murray L. Miller, Member Version 06/01/2022 By (Signature) (Printed Name of Person Signing) ACCEPTANCE day of 20 Joseph R. Molnar, Vice President Jordan V. Gathers, Member Attest: Theresa Heffner, Clerk Page - 8 Public Works Quote Firm: Address: E )�'s s-, 1. Pe tt L t', City/State/Zip: __<_ Telephone Number: Fax Number: ( 1 By�'l�� 1 t; (Signature) �- (PrPhted Name of Person Signing) Version 06/01/2022 Page - 21 Public Works Quote When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit. CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON-DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS (Must be completed for all quotes and bids. Please type or print) STATE OF SS: p, WC— I o tJ COUNTY ) The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury that: 1. Contractor has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and 2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency; and 3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investment activities in Iran. a. For purposes of this Certification, "Iran" means the government of Iran and any agency or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from time -to -time. b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor is engaged in investment activities in Iran if either: i. Contractor, its successor or its affiliate, provides goods or services of twenty million dollars ($20,000,000) or more in value in the energy sector of Iran; or ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty million dollars ($20,000,000) or more in credit to another person for forty-five (45) days or more, if that person will (i) use the credit to provides goods and services in the energy sector in Iran; and (ii) at the time the financial institution extends credit, is a person identified on list published by the Indiana Department of Administration. 4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the Contractor subsequently learns is an unauthorized Version 06/01/2022 Page - 17 Public Works Quote 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, firms, partnerships, corporations, associations, or joint venturers awarded a contract by the City of South Bend through its agencies, boards, or commissions shall not discriminate against any employee or applicant for employment in the performance of a City contract with respect to hire, tenure, terms, conditions, or privileges of contract or employment, or any matter directly or indirectly related to contracting or employment because of race, sex, religion, color, national origin, ancestry, gender expression, gender identity, sexual orientation, or due to age or disability that does not affect that person's ability to perform the work. In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials, or any combination of the foregoing including, but not limited to, public works contracts awarded under public bidding laws or other contracts in which public bids are not required by law, the City, its agencies, boards, or commissions will consider the Contractor's good faith efforts to obtain participation by those subcontractors certified by the State of Indiana as a Minority Business ("MBE") or as a Women's Business Enterprise ("WBE") as a factor in determining the lowest, responsible, responsive bidder. Contractors seeking the award of a City contract cannot be required to award a subcontract to an MWBE; however, they may not unlawfully discriminate against said MBE/WBE. On goal -eligible contracts, Contractors are required to either meet both MBE and WBE utilization goals or demonstrate that the Contractor has made good faith efforts to obtain participation from MBE and WBE subcontractors. A finding of noncompliance or a discriminatory practice shall prohibit that Contractor from being awarded a City contract for a period of one (1) year from the date of such determination, and such determination may also be grounds for terminating the contact to which the discriminatory practice or noncompliance pertains. 7. The undersigned Contractor agrees that the following nondiscrimination commitment shall be made a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its agencies, boards or commissions. Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the performance of this contract with privileges of employment, or any matter directly or indirectly related to employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation, handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of contract. Version 06/01/2022 Page - 18 Public Works Quote 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 (I.C. 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 affirm under the penalties of perjury that the facts and information contained in the foregoing bid for public works are true and correct. Dated this % day of i—M`� 20 2--3 P4k-f i tomet Contractor/Bidder (Firm) Signature of Con actorBidder or Its Agent iy ,p- `' l l] &W vk ik /u Printed Name and Title Subscribed and sworn to before me this 10 day of Nrl 0'4'� / iu�� 20 L 3 My Commission Expires fo Z�'Z� �`' Notary Public County of Residence LA r J-r-i CURT S PICKARD Notary Public - Seal Marion County - State of Indiana Commission Number NP0744596 My Commission Expires Oct 27, 2030 Version 06/01/2022 Page - 19 Public Works Quote ti T �f4 QUOTE/PROPOSAL CITY OF SOUTH BEND % PROJECT NAME Century Center Parking Lot Seal and Stripe PROJECT NO. 122-06013 QUOTES DUE April 11"', 2023 at 9.00am EST to bpwbidsCa)southbendin.gov lasequote — yvertay of Cuit ul yclllVl 1 .. aura Descri tion - Quantit Unit Unit Price Total Amount Item No. 1 MOBILIZATION AND DEMOBILIZATION 1 LS ct ��Uf� �„ 2 PARKING BLOCK, RESET 5 EACH 3 PARKING BLOCK, NEW 47 EACH _ t to �� >C I Q0^ 3 LIQUID ASPHALT 16000 SYS I, O g 3� )-Vcw 4TPAVEMENT OTHOLE PATCHING 750 SFT ��, ZZ �� J (r5 MARKING, ACCESSIBLE 14 EACH Lt `7%(� 5 YMBOL CIO 6 PAVEMENT MARKING, PAINT, 4 IN PAVEMENT MARKING, PAINT, 9800 LFT (y p 450 LFT w� ,� n70 7 ANGLED STRIPE Total Amount of Base Quote _ $ Alt to #1— Rear Entrance Parkin Lot and Drive erns Item No. Description Quanti Unit Unit Price Total Amount 1 LIQUID ASPHALT 1500 SYS 08 CC I fJ 150 SFT j g 33 2 POTHOLE PATCHING ,ZZ 3 PAVEMENT MARKING, PAINT, 4 IN 360 LFT y L,C, Total Amount of Alternate Total Amount of Base Bid and Alternate Ek�l Version 06/01/2022 Page - 20 Public Works Quote CITY OF SOUTH BEND C MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE-1.0 �d 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 or woman business meets the MBE qualifications. Project Number: Bidder: 122-060B Project Name: Century Center Parking Lot Seal and Stripe V/y%fz Ukfru( JV4(N�-A -Total Bid Amount: -LE MBE Goal: 4.3% Page % of Name 8 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 AJ �fv Submitted by: 64,a, a �� I.tr wttA0 1 Print Name Signature c / -Z3 Date Version 06/01/2022 Page - 22 Public Works Quote tJ 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 minority or woman business meets the WBE qualifications. Project Number: Bidder: 122-060B Project Name: Century Center Parking Lot Seal and Stripe lyb �ivU�st HIV +i � NV I�f4tN ,u, Total Bid Amount: WBE Goal: 6.1% Page t Of Name &Address of WBE �(Nameffelephone) Scope of Work to be Performed TDollar (Attach scope/schedule 'rf you need additional space)Component Amount of WBE Percentage of Total gldlpro osal , w tL �`uu~�st�c ru� ( �g F t 6v1 A-S c� PAU i— t2 �t � 11ti ' � -`duo -` ! # ;L3(. SL.. rN `l e 3 7 At 5 ;2 'i ti 3 vS �La wt ,2.8Z- U7 { i�iC� 2� CA t-S Submitted by: O` bJ�L(A/J � Print Name Signature Date -//, 0 /2-3 Version 06/01/2022 Page - 23 Public Works Quote CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN - FORM MBE-2.0 EVIDENCE OF GOOD FAITH EFFORTS This completed form should be included as part of the Bids documents related to City of South Bend Public Works Proiects requiring Good Faith Efforts to obtain MBE participation. Project Number: Project Name: Bidder: Contact Person: Address: City: Email: 122-060B Century Center Parking Lot Seal and Stripe Date: f // C 1 -� l VAUk(kAAA i Telephone:ji 7 ') J C y' o(ANAV d b S State: t h1 Zip: ct l` N H d 'N J M• %; S C (jiv ^-- To determine whether a bidder has demonstrated good faith efforts to reach the MBE utilization goal 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 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.clov/idoa/. GOOD FAITH EFFORTS TO OBTAIN MBE PARTICIPATION The bidder shall initial each item below, as evidence of its good faith efforts to obtain MBE participation in the awarded contract. I affirm that I reviewed the City of South Bend's Minority and Women Business Enterprise Inclusion Program Plan and the Indiana Department of Administration's certified list of Indiana Minority and Women Business Enterprises, found on their website (http://www.in.gov/idoa). I affirm that I have made good faith efforts to select portions of the contract work to be performed by MBEs, including, where appropriate, breaking out contract work items into economically feasible units to facilitate MBE participation. I affirm that 1 have made good faith efforts to solicit through all reasonable and available the interest MBEs in the scopes of work of the contract. means of all I affirm that I attended all pre -bid meetings scheduled by the City of South Bend to inform opportunities. MBEs of contracting and subcontracting I affirm that I advertised in general circulation and/or trade association publications �1 concerning subcontract opportunities and allowed MBEs reasonable time to respond to such advertisements. I affirm that 1 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 MWBEs to participate effectively. I affirm that I followed up on initial solicitations with interested MBEs. I affirm that I negotiated with interested MBEs in good faith, including providing such MBEs with adequate information about the plans, specifications and other requirements of the subcontract. I affirm that I have made good faith efforts to assist interested MBEs in obtaining bonding, lines of credit, or insurance as required by the City or the bidder, where appropriate. Version 06101/2022 Page - 24 Public Works Quote 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 where appropriate. equipment, supplies, materials, or related assistances or services, I affirm that I did not reject any MBEs as unqualified without sound business reasons based thorough investigation of their capabilities. on a 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 06/01/2022 Page - 25 Public Works Quote CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN _ FORM WBE-2.0%'' EVIDENCE OF GOOD FAITH EFFORTS This completed form should be included as part of the Bids documents related to City of South Bend Public Works Projects requiring Good Faith Efforts to obtain WBE participation. Project Number: 122-060B Date: Z '� Project Name: Century Center Parking Lot Seal and Stripe Bidder: N�a�} i tvti.4� i;t V.��r� 6MrS►rrti rr� tItrL ! Contact Person: isV �Lt �� Ly µ'1 r ti( Telephone: Address: / d� l`� C�►u�' �� S City: State: Zip: Email: `� r t` " %y ''t "' `' L k^ 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, ocf 09= a 1 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: httr)://www.in.qov/idoa/. GOOD FAITH EFFORTS TO OBTAIN WBE PARTICIPATION The bidder shall initial each item below, as evidence of its good faith efforts to obtain WBE participation in the awarded contract. I affirm that I reviewed the City of South Bend's Minority and Women Business Enterprise Inclusion Program Plan and the Indiana Department of Administration's certified list of Indiana Minority and Women Business Enterprises, found on their website (http://www.in.gov/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 MWBE participation. 1 affirm that I have made good faith efforts to solicit through all reasonable and available means the interest of all WBEs in the scopes of work of the contract. I affirm that I attended all pre -bid meetings scheduled by the City of South Bend to inform WBEs of contracting and subcontracting opportunities. I affirm that I advertised in general circulation and/or trade association publications concerning subcontract opportunities and allowed WBEs reasonable time to respond to such advertisements. I affirm that I performed any and all necessary steps to provide written notices in a manner reasonably calculated to inform WBEs of subcontracting opportunities and allowed sufficient time for WBEs to participate effectively. 1 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, lines of credit, or insurance as required by the City or the bidder, where appropriate. Version 06/01/2022 Page - 26 Public Works Quote CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN 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 WBE was unqualified to perform the job. _�_ .-.-.a �.- -n .-f Fk- �i.nvn hnvac Any *Proper demonstration of Good Fn arm Efforts requires your iruara i16^1 — — ----- -- -_____. _ .__ 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 06/01/2022 Page - 27 Public Works Quote om)1:1H U `t��. CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE-2.1 MBE CONTACTED This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring Good Faith Efforts to contact MBEs. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the MBE qualifications. Attach additional pages if necessary. PAGE / OF / Project Number: 122-060B MBE Participation Goal 4.3% Project Name: Century Center Parking Lot Seal and Stripe ` Bidder: ��'1 1 ::: � �Ud�. r`i ,1 �, f V�&i K.�,,t A1y C. I- By: (Signature) (Title) (Date) MBE Firm Z'fj t4 Iq cu,) t L C Crooner or Contact at MBE Firm € fkr'IA,4r{ U :} /,t i.0 itt4k .5 (In � Telephone: 31 - S 1 4- Fax: Email: ,1L"i&, 1r�aL.j ,,, ��5 G � �I�v�i � • �vl� TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBE FIRM: tp x4-- ct- 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 06/01/2022 Page - 28 Public Works Quote L CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM WBE-2.1 WBE CONTACTED This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring Good Faith Efforts to contact WBEs. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the WBE qualifications. Attach additional pages if necessary. PAGE OF Project Number: 122-060B WBE Participation Goal 6.1 % Project Name: Century Center Parking Lot Seal and Stripe Bidder: By: /`�cv"v� �/ ^ iiLtGrt.vt �' t- (Signature) (Title) (Date) WBE Firm i4 Lf G Owner or Contact at WBE Firm Telephone: 94—,k-t Fax: Email: �e21 ��,,r�Lccn R✓?e�1r?1•cd'1^ TYPE OF WORK SOLICITED FOR THIS PROJECT: tZ t a C 2 l H (�l�4if�e h.t. € at ( RESULTS OF CONTACT WITH THE WBE FIRM: v WBE Firm sAA"i6 (3A Zf , c- Owner or Contact at WBE Firm Telephone: 7q - Z S7 - 7o S Fax: Email < 4.,, ��,�yv, is � w•i c (. wrl � k � �� � � e�� < r L TYPE OF WORK SOLICITED FOR THIS PROJECT: (Zr ct`I 5 a n IZt �r�C RESULTS OF CONTACT WITH THE WBE FIRM: (,U i Version 06/01/2022 Page - 29 Public Works Quote �►� CERTIFICATE OF LIABILITY INSURANCE DATE /13/2 23 003/13/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. N SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Brandy Shotts McCammon Agency Corp PO BOX 418 Cloverdale, IN 46120 ACT NAME: Brandy Shotts-Jay PHONE 217-251 4043 A/C No No A- a6: brandys@mccammonagency.com INSURERS AFFORDING COVERAGE NAIL # INSURER A ; Hastings Mutual INSURED National Pavement Maintenance LLC 1928 N Campbell Ave Indianapolis, IN 46218 INSURERS: INSURER C : INSURER D : INSURER E; INSURER F : nwre An_e& c092'"Fif TE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTRTYPE LTR OF INSURANCE �� SUBR POLICY NUMBER MMIDPOLICY EFF UM Y EXP LIMA GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000,000 DAMA E TO RENTED PREMISES Ea occunence $ 1000,000 MED EXP (Any one person) $ 5,000 A CLAIMS -MADE IF;N;;] OCCUR X 6165438 08/10/2022 08/10/2023 PERSONAL & ADV INJURY $ 1000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 $ POLICY PRO- JECTLOC COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY Ea accident BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ A ALL OWNED SCHEDULED X AUTOS AUTOS X HIRED AUTOS X qNON-OWNED X 6185615 03/12/2023 03/12/2024 PROPERTY DAMAGE Per accident $ $ A X UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE X 6290555 07/29/2022 07/29/2023 EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 -.EDT-[RIENTION$ $ WORKERS COMPENSATION - WC STATUS OTHR ER TS AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) GEH I IVIGA I L NULULK MIYV GLLN I rvrr SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of South Bend THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Brandy Shotts-Jay ACORD 25 (2010/05) l0 I`J2f0-,dUIU A%.UrSU l vnrvntarwlr. 'au nynw rcaclrcU. The ACORD name and logo are registered marks of ACORD