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Opening of Bids - The Hill TIF Project – Site Work Proj No. 123-030 - Premium Concrete Services
CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK Project Name 'The Hill' TIF Project —Site Work Project No, 123-030 For Bids Due Tuesday, May 9, 2023 @ 9:00 AM EDT via email to BPWbids@south bendin.gov PART (Must be completed for all bids. Please type or print) Date: 5/8/Z3 Bidder (Firm): PREMT-tlo*/ C4W44Er41r. lam'"✓razes Address: % lOz 9tc-M~000 Si City/State/Zip: �4cMARr�1ir% S/G Telephone Number: (5w ` ) 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: Site Work for'The Hill' TIF project located at 611 N. Notre Dame Avenue the City of South Bend, Indiana, in accordance with plans and specifications prepared by: Danch, Harrier & Associates, Inc. and dated April 14, 2023 for the sum of (enter the Total Bid as shown on the Proposal) O FOuR l46(NORRA-RaePAy-Ez6mr7/46us4n/n sax lk"MaO, .r0gry.ME ($ yt60 &w ? ) (Enter sum of Total Base Bid plus Alternates shown on Proposal) Oo"6 5 (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 attachrr By _tc//� ^ n YQ09 (tgnature) Y (Printed of Person Signing) The above bid is accepted this Subject to the following conditions: BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Gary A. Gilot, Member Murray L. Miller, ACCEPTANCE day of Joseph R. Molnar, Vice President Jordan V. Gathers, Member Attest: Theresa Heffner, Clerk Version 09/29/2021 Contractor's Bid for Public Works - 2 CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK CHECKLIST FOR BIDDERS Project Name `The Hill' TIF Project —Site Work Project No. 123-030 For Bids Due Tuesday, May 9, 2023 @ 9:00 AM EDT 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 or Bid Bond. Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely V executed. Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and t/ 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 WBE-2.1]. ✓ Acknowledge Receipt of � Addendum(s) included with the bid. ✓ 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. V This checklist submitted with the Bid. This checklist is provided for bidder's use in assuring compliance documentation; however, it does not include all specifications requirements relieve the bidder of the need to read and comply with the specifications. Z3 Bidder: PR£.nrua jcR�TE ConDate: By Authorized Representative: � ' Signature: / with required and does not Version 09/29/2021 Contractor's Bid for Public Works - 1 =AI [locument� lffll," 2010 B-IL0omillitt CONTRACTOR: SURETY: (Name, legal status and address) (Name, legal status and principal place Premium Concrete Services, Inc. of business) Old Republic Insurance Company 712 Richmond St P. O. Box 0941 This document has important legal Elkhart, IN 46516 Brookfield, WI 53008-0941 consequences. Consultation with an attorney Is encouraged with OWNER: (Name, legal status and address) respect Its completion or City of South Bend Board of Public Works modification. County -City Building Room 1316, 227 West Jefferson Blvd Any singular reference to Contractor, Surety, Owner or South Bend, IN 46601 other party shall be considered BOND AMOUNT: Five Percent of the Total Bid 5 % of Total Bid plural where applicable. PROJECT: (Name, location or address, and Project number, if any) The Hill' TF Project - Site Work, Project No. 123-030 The Contactor and Surety are bound to the Owner in the amount set forth above, for the payment of which the Contractor and Surety bind themselves, their heifs, 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 Contactor, 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 Ure amount specified in said bid and such larger amount for which the Owner may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. The Surety hereby waives any notice of an agreement between the Owner and Contactor to extend the time in which the Owner may accept the bid. Waiver of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for acceptance of bids specified in the bid documents, and the Owner and Contactor 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. Signe ud sealed tl is 3rd day of May 2023 remiu to Services (Principal) (Seal) (Wi ness) (Title) ��� "r01" Old Republic Insur nce Companv 1us -IFia D� _ in1� QtYV�� (Surety) ;r (Witness) (Title) CAUTION: You should sign an original AIA Contract Document, on whic is text appears in RED. An original assures lhaf""'aru changes will not be obscured. Init, AIA Document A310T"' —2010. Copyright ©1963, 1970 and 2010 by The American Institute of Architects. All rights reserved. WARNING: This A19 Document Is protected by U.S. Copyright Law and Intemational Treatles. 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. Purchasers are permitted to reproduce ten (to) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of 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, III, WESLEY MANTOOTH, THERESA BURNS, JORDAN SCHEIRER, LISA M THOMAS, FAITH HUNT, PAMELA S. HIGGINBOTHAM of SOUTH BEND, IN its true and lawful Allorney(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 seated 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 surely 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 chairmen, president or anyvice president of the Company's surety division and attested and sealed (ifa seal be required) by any secretary or assistant secretary; or (it) 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 OLD REPUESLIC /NS )rye, E COMPANY CVice /President W�W��W�%��rtl�' =S g� STATE OF WISCONSIN, COUNTY OF WAUKESHA-SS On this 30th day of November 2022 ,personally came before me, Alan Pavlic and Karen I 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. 9;;AUgt-�G 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. SEAS 3rd May 2023 SEAI. € Signed and sealed at the City of Brookfield, vN this day of Y 45-5314ge x �� oast Woos (mo) ,",,,,, � ns;,atem see, e y GIBBON INSURANCE AGENCY, INC. PART II 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 (i.e. persons or firms outside your own firm who have performed part of the work) that you have used on public works projects during the past five (5) years along with a brief description of the work done by each subcontractor. 3. If you intend to sublet any portion of the work, attach the name and address of each subcontractor, equipment to be used by the subcontractor, and whether you will require a bond. However, if you are unable to currently provide a listing, please understand a listing must be provided prior to contract approval. Until the completion of the proposed project, you are under a continuing obligation to immediately notify the City of South Bend in the event that you subsequently determine that you will use a subcontractor on the proposed project. 4. Attach a listing of equipment you have available to use for the proposed project. 5. Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing your proposal? If not, attach an explanation for the rationale used which would corroborate the prices listed. SECTION III CONTRACTOR'S FINANCIAL STATEMENT Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial statement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to the City of South Bend awarding the contract must be specific enough in detail so that said City of South Bend can make a proper determination of the bidder's capability for completing the project if awarded. Version 09/29/2021 Contractor's Bid for Public Works - 3 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 AMOUNT COMPLETI ON DATE OWNER $ 570,000.0O STREETSCAPE 6/2/23 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 WORI<THAT WAS AWARDED TO US. 4) REFERENCES: a. NISOURCE-MR. LUI<E BRADLEY-1039 PENNSYLVANIAAVE SOUTH BEND, IN 46601 b. COZIER MANUFACTURING - MR. KEN 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: "The Hill" TIF Project —Site Worl<#123-030 -Schedule: After given the notice to proceed, Premium Concrete Services, Inc. will review, establish work area and layout area. We will then contact Indiana 811 to locate all utility lines within construction limits. Next will be erosion control, inlet protection, removals, excavation, grading, and underground work with a 3-man crew. Then layout with 2-man crew. Forming, doweling, and pouring of concrete will be next with a 5-man crew. Dumpster enclosure masonry work and landscaping will be completed by subcontractors. We will also utilize subcontractors for hauling. Multiple crews may be working at the same time. 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) Kennedy Expressline —4324 Ashard Dr South Bend, IN 46628 — Trucking 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: Skid Steer, Mini Excavator, Excavator, Compactor, Roller, Wall -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. When the prospective Contractor is unable to certify to any of the statements beloip, 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 U I AN R ) ) SS: ELKFiA P T COUNTY ) The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury that: I. 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. 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 tan 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,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 dollaz's ($2Q,000,000) or more in credit to another person for forty-five (45) days or more, if that person will (i) use the credit to provides goods and services in the energy sector in Iran; and (ii) at the time the financial institution extends credit, is a person identified on list published by the Indiana Department of Administration. 4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the Contractor subsequently learns is an unauthorized alien. Version 09/29/2021 Contractor's Bid for Public Works -4 Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of Contractor's newly hired employees through the E-Verify Program as defined by LC. 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 learn% is an unauthorized alien, and that the subcontractor has enrolled ill and is participating in the E-Verify Program. Tire Contractor agrees o 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 Wonen'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. Oil 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 agaiust or intimidate any employee or applicant for employment in the performance of this contract with privileges of employment, or any matter directly or indirectly related to employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation, handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of contract. 1, the undersigned bidder or agent as contractor on a public works project, understand my statutory obligations to the use of steel products or foundry products made in the United States (I.C. 5-16-8-1).1 hereby certify that I and all subcontractor 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 nueasonable. Prior to award and upon submission of bid which does not use steel products or foundry products made in the United States, the City, through its director of public works, shall make a determination if the price of United States made steel or foundry is unreasonable. I understand that violations hereunder Version 09/29/2021 Contractor's Bid for Public Works - 5 may result in forfeiture of contractual payments. xx� 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 _ 1 ' /y� tint-, 20a_3 1+'E lu m�o�JCR CTE SERU I YN C Contractor/Bidder (Firm) Signature of Contract r/Bidder or Its Agent MAXy AKCY V.P- Printed Name and Title Subscribed and sworn to before me this i5 day of �a My Connnission Expires 11 a0a�0 �t Not y Public c County of Residence Fi-KN APT JANEE M TOWNER NOTARY PUBLIC ELKHART COUSEAL NTY, STATE OF INDIANA MY COMMISSION EXPIRES FEBRUARY 12, 2026 COMMISSION NO.710399 Version 09/29/2021 Contractor's Bid for Public Works - 6 �4�rV1'H gF�''e i BIDIPROPOSAL`'�'' CITY OF SOUTH BEND Project Name: `The Hill' TIF Project —Site Work Project Number: 123-030 For Bids Due: Tuesday, May 9, 2023 @ 9:00 AM EDT Contractor Name: puraw! cD 06A�TE j;i(J tGE S Item Description Quantity Unit Unit Price Total Amount No, 1 Lump Sum price to perform all site work 1 LSUM g124 as indicated on Plans 2 Landscape Lighting Allowance 1 EA $4,500 $4,500 BASE BID TOTAL 4 cpFT ow r f1Fr111CT AI TERNATES Item Description Quantity Unit Unit Price Total Amount No. 1 Provide deduct price to remove Asphalt 1 LSUM 14R q W `` Sealingand Striping from Bid 2 Provide deduct price to remove 1 LSUM �7i �Sp i i$0 Foundation Plantings 3 Provide deduct price to remove Gravel 1 LSUM 3, 0&0 113 bDU Drive Bidder (Firm): Address: City/State/Zip: (Signature) (Printed Name of Person Signing) Version 09/29/2021 Contractor's Bid for Public Works - 7 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE-1.0 jr 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: 123-030 Project Name: `The Hill' TIF Project —Site Work Bidder: Total Bid Amount. ta�Z�. &C,�1 MBE Goal: 2.0% Page { of d 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 BidlPro oral j 5 rC Cif 5 LOGy 5T1L5 .2z13 5� Ci3r1^.rx—> Avg. 70rdTh i3s.v.�iSti YL-Gig/ 13Ear ef20 �S7`i�i43-��/ %l L1G.�yst. �,. ov (f,IUC �' � L, I Submitted by: Version 09l29l2021 ,4,V Y,�:1 a Print Name Signature Contractor's Bid for Public Works - 8 i 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: 123-030 Project Name: `The Hill' TIF Project —Site Work Bidder: &1l�G€TE- 5zWy4��iotal Bid Amount: 2c�, 6 0/0 = WBE Goal: 4.9 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 s�kJ Submitted by: r 4x YZ4,kE Print Name Signature Version 09/29l2021 Contractor's Bid for Public Works - 9 Date CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN`\ FORM MBE-2.0 \x,,- ^./ 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: 123-030 Date: -- Project Name: The Hill' TIF Project —Site Work __ Bidder: '' ixEJ xulil r%'0, A)CAL Contact Person: 1�Gj ,err✓.-,L"1� Telephone: Address: City: Lk %YFdL I State: �IA") Zip: /lv. Email: &'6rZRCe) f/PJe GC'AlexkrCDIJeeius.Cov" 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 by the City; and 3) the Indiana Department of Administration list of Minority and Women Owned Businesses (both certified and non -certified) found at: htto://www.in.aov/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 htt ://www.in. ov/idoa . 1 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. �ry I affirm that I have made good faith efforts to solicit through all reasonable and available '+L'7 means the interest of all MBEs in the scopes of work of the contract. n I affirm that I attended all pre -bid meetings scheduled by the City of South Bend to inform MBEs of contracting and subcontracting opportunities. ){l� 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. 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 09/29/2021 Contractor's Bid for Public Works - 10 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM 1V1BE-2.f1 EVIDENCE OF GOOD FAITH EFFORTS 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. �� 1 affirm that I did not reject any MBEs as unqualified without sound business reasons based on a thorough investigation of their capabilities. CONTRACT RECORDS: The bidder has maintained the following records for each MBE that has bid on the subcontracting opportunity: 1. Name, address, and telephone number; 2. A description of information provided by the bidder or subcontractor; and 3. A statement of whether an agreement was reached, and if not, why not, including any reasons for concluding that the MBE was unqualified to perform the job. *Proper demonstration of Good Faith Efforts requires your initials next to all of the above boxes. Any omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of South Bend reserves the right to request additional information. Version 09/29/2021 Contractor's Bid for Public Works - 11 CITY OF SOUTH BEND `r/F MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLANT FORM WBE-2.0 EVIDENCE OF GOOD FAITH EFFORTS This completed form should be included as part of the Bids documents related to City of South Bend Public Works Projects requiring Good Faith Efforts to obtain MWBE participation. Project Number: 123-030 Date: -sb/2 Project Name: The Hill' TIF Project —Site Work __ Bidder: Contact Person: w R00 XaLG�.Ci� _ Telephone: �"2iJ �(�y�1 e� Address: ?I2 S 7� City: Email: �IZL0r-11' d./J 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 L' Indiana Minority and Women Business Enterprises, found on their website hit ://www.in. ov/idoa . I affirm that I have made good faith efforts to select portions of the contract work to be ei )� 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. 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 09/29/2021 Contractor's Bid for Public Works - 12 tnlU' G� CITY OF SOUTH BEND 4 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. ?JJ1I''''// I affirm that did not reject any WBEs as unqualified without sound business reasons based on a thorough investigation of their capabilities. CONTRACT RECORDS: The bidder has maintained the following records for each WBE that has bid on the subcontracting opportunity: 1. Name, address, and telephone number; 2. A description of information provided by the bidder or subcontractor; and 3. A statement of whether an agreement was reached, and if not, why not, including any reasons for concluding that the MWBE was unqualified to perform the job. *Proper demonstration of Good Faith Efforts requires your initials next to all of the above boxes. Any omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of South Bend reserves the right to request additional information. Version 09/29/2021 Contractor's Bid for Public Works - 13 � it CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN s�,_3 c AAct. 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 minorityowned business meets the MBE qualifications. Attach additional pages if necessary. PAGE OF Project Number: 123-030 MBE Participation Goal 2.0 Project Name: The Hill' TIF Project -Site Work Bidder By:D✓/'� i St z .r/dTOrC 5_'? (Signature) (Title) (Date) MBE Firm f ��L-h1s5 L&(,17.5I.LG.s C:-L�--- Owner or Contact at MBE Firm rN N-t2 f.� 6141� CtrLEAZ Telephone�,5 7y)� 1,j-cti.> 7/ Fax: Email: �$-i'-C'Ct}5'S GoGyS j-+'�S;,L�BIIr'-6i1�'G•w�"1 TYPE OF WORK SOLICITED FOR THIS PROJECT: T�GtGk�x-stJ 6 RESULTS OF CONTACT WITH THE MBE FIRM: - iit):1-LL ttA T"S LxL a�C JF 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 - 14 U O� I! CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN I / FORM MBE-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 woman -owned business meets the WBE qualifications. Attach additional pages if necessary. PAGE OF Project Number: Project Name: Bidder: By: 123.030 `Tyh�e Hill' TIF Project —Site Work WBE Participation Goal 4.9% Owner or Contact at WBE Firm Telephone: Ie 2 jq .4')ce Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: -"j R ttc kx nL) C RESULTS OF CONTACT WITH THE WBE FIRM: Z JEF 4 14AO�L� Owner or Contact at WBE Firm Telephone: (JGrS' c/" "3lb'i/ Fax: h7-" 611�7z-t TYPE OF WORK SOLICITED FOR THIS PROJECT: j� J� " V C. RESULTS OF CONTACT WITH THE WBE FIRM: (Date) Email: �'jt'7"C'.- �/G-C:in7�iK uct+=w'✓r'•IP✓'G y, CGu�I Version 09/29/2021 Contractor's Bid for Public Works - 15 13I6 COUNTY -CITY BDILDMG 227 W. JEFFERSON BOULEVARD SOUTH BEND, INDIANA 46601-1830 Date: Mav 2, 2023 PHONE S74/235-9251 Fax 574/ 235-9171 TDD 574/ 235-5567 CITY OF SOUTH BEND, TAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS. To: All Planholders From Theresa Heffner, Clerk, Board of Public Works Subject Addendum Number: 1 Project Name: 'The Hill' TIF Project — Site Work Project Number: t 23-030 ACKN®SRJV_,EI�CEI�If]C1�1'fl' ®IF RECEIB�' ��' ADDEI�1�➢iUIV[i Date Received: 5/3 /,23 This addendum is being folwarded to you for the above referenced project. Please sign below and acknowledge receipt of this Addendum by including with your electronic bid submission. THIS ADDENDUM MAY AFFECT YOUR BID. Notes: The attached documents are hereby added to the Specifications and Contract Documents and become a part of herein. Company: �%7'Lin=uN� CO�tJGRET� 5�2U�G� S Authorized Signature: Date: S�3 Version 8/11/2020 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, TAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS Date: May 5 2023 To: All Planholders From Theresa Heffner, Clerk, Board of Public Works Subject Addendum Number: 2 Project Name: `The Hill' TIF Project —Site Work Project Number: 123-03t1 Date Received: 6 [ 5_/, This addendum is being forwarded to you for the above referenced project. Please sign below and acknowledge receipt of this Addendum by including with your electronic bid submission. Notes: The attached documents are hereby added to the Specifications and Contract Documents and become a part of herein. Company: Authorized Signature: Date: Version 8/I1/2020 Project Name `The Hill' TIF Project —Site Work Project No. For Bids Due Tuesday, May 9, 2023 @ 9:00 AM EDT Contractor Name: PREMIUM CONCRETE SERVICES 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 11 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 3151 for the upcoming calendar year, or within twelve (12) months of obtaining pre - qualified standing. If the status of any item changes within the twelve (12) months, it is the responsibility of the contractor to notify the City. Failure by any pre -qualified contractor to submit its complete application for continuation of"pre-qualified" standing within the time prescribed above shall result in automatic removal of the designation, effective January 1 of the following year, or immediately following the twelve (12) months of pre -qualified standing. However, the "removed" contractor or subcontractor shall still be permitted to bid on City public works projects, though the contractor must submit all required documents under 6-63 until "pre -qualified" status is re-established. Please Note: The City reserves the right to request supplemental information from the bidder, additional verification of any information provided by the bidder, and may also conduct random inquiries of the bidder's current and previous customers regardless of pre -qualified standing. It is the sole responsibility of the potential bidder to comply with all submission requirements applicable to the bidder in Section 6-63 of the Responsible Bidding Ordinance no later than the date of the public bid opening. 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 Subcontractor(s)") to the City by a bidder shall not create any rights in the Disclosed Subcontractor(s). Thus, a bidder may substitute another subcontractor for a Disclosed Subcontractor by giving the City, upon request, written notice of the name, address, licensing status, and type of work of the substitute subcontractor. 5. The successful bidder and all subcontractors on a public works project are required to submit certified payroll utilizing the federal form known as WH-347 or a similar form on a bi-weekly basis, submitted within 10 days after the end of each bi-weekly payroll period. Certified payrolls shall identify the job title and craft for each employee. Certified payrolls shall be submitted electronically. Please Note: Submissions deemed inadequate, incomplete, or untimely by the City may result in the automatic disqualification of the bid. The City, after review of complete and timely submissions, shall, in its sole discretion, after taking into account all information in the submission requirements, determine whether a bidder is responsive and responsible, and provide a Pre -Qualification Verification Letter. The City specifically reserves the right to utilize all information provided in the contractor's submission and any information obtained by the City through its own independent verification of the information provided by the contractor. Version 02/23/2022 General Conditions - 11 PRE -QUALIFIED BIDDER CHECKLIST (a) Acknowledgements: ey checking this box, hereby acknowledge ihat 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. (it) _ 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). (it) _ 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 II. PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED) (a) Acknowledgements: (i) _✓ By checking this box, I hereby acknowledge that I am not a pre -qualified bidder With the City of South Bend. (ii) By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided, and may also conduct random inquiries of my current and prior customers. The City reserved the right to utilize all information provided in this submission and all information obtained in inquiries or requests to determine if a bidder is responsive and responsible. Additionally, I acknowledge that all information provided to the City shall be regarded as public records. (iii) ✓ By checking this box, I hereby acknowledge that copies of all Applicable apprenticeship certificates or standards for training programs applicable to the work performed on the project may be requested at anytime and shall be furnished / 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 on-line records Ile, 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) N (a List identifying all former business names. (III) Nan 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 Date: (ix) / 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. s/ 5 / 02 3 (Sign Here) JIF MV YLAKEy (Print Name Here) rREAItu. i COAX4ETT- Kf dZ(:,E 5 (Name of Company) i/z /ZZtf0 4A0 sT (Address of Company) LK#Aot r S/J (State) (Telephone Number) Version 02/23/2022 General Conditions - 14 State of Indiana Office of the Secretary of State CEfi'fIFICATE OE EXISTENCE To Whom'fhese Presents Come, Greeting; I, HOW SULLIVAN, Secretary of State of Indiana, do hereby certify that I ain, by virtue of the laws of the State of Indiana, the custodian of the corporate records and the proper official to execute this certificate. 1 further certify that records of this office disclose that duly filed the. requisite documents to commence }tUsingss activities under the laws of the State of Indlana on November 24, 2004, and was in existence oriauthorized to transact 'buslness .�;the State of Indiana on March 01, 2022 further certify this Domestic For- Profit Corporation has filed its most recent report required by Indlana law with the Secretary of State, or Is not VbUrequired to file such report, and that no notice of withdrawal dlssaliition, or expiratlon has been (ilW or taken place. All fees, taxes; -interest, and penalties owed to Indiana by the=:domestic or foreign entity ana collected by the`'Secretary of State have been paid. In Witness Whereof, I have Lcaused to be affixed my sit nature el d the seal of the State of Indiana, at the City of Indianapolis; March 01, 2022 HOLLI SULLIVAN SECRETARY OF STATE 20049.2,0100105/20222461045 Ail certificates should be validated here, https://bsdsos.ln.gov/ValidateCertificate Expires on March 31, 2022. 0 Premium Services dba Premium Services 712 Richmond Street Elkhart, IN 46516 574-264-0196 fax 574-266-5392 May 8, 2023 To Whom it may concern, Premium Concrete Services, Inc. dba Premium Services, currently employs thirty-nine (39) people. Five (5) of which are field supervisors, eight (8) concrete finishers, twenty (20) laborers, and six (6) 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 Vice -President 0 Premium Services dba Premium Services 712 Richmond Street Elkhart, IN 46516 574-264-0196 fax 574-266-5392 May 8, 2023 To Whom it may concern, Premium Concrete Services, Inc., dba Premium Services, 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 Yeakey Vice -President 1'o Whom h May Concern; This is n teller to inform you that Premium Concrete Scrviccs, Inc., is a contractor' member' of the Building & Construction Resource Center Ina (BCRC) drug testing Progr<un. They are n contributing client and meet all the industry Standards set try the Business Roundtable of Northwest Indiann, the Substance Abuse & Mental Health Services Association, and the Drug & Alcohol Testing Industry Association, and the Department of Transportation. Please be ndvisad that Premium Conm•cte Scrviccs, Inc, located at 7I2 Richtnmtd St, rlkhart, iN 4651( is n participating employer in good standing with BCRC. Alt of Premium Concrete Services, hne,'s Pmployces are subject to the terms orthe BCRC Drug Testing Policy, which meets or exceeds the requirements of IC 4-13-18-5 0• IC 4.1348-6. Please direct auy questions regarding this eorrespoudence to me. Sincerely, Laticin Roach 1✓xecutive Dit'ector BCRC Administrator, hnc. 219464-1488 Piorrttnlincl Ihc; Saioly anel Wcrll-l3Eelnd of Irnploy(3es in Ilu; UVgrkplact: Nuilding �Cnaslrurlinu Rr�anurreCenler, Inn, � I'ham: (2'19) 784-9GOQ � 1'n.r; (2'19) 764-9505 (i0.5() SuuHrpnrf IZaril, Suile 13 o Parlage, Iruliana 4636S ^ eu2rNtr.br'roriuLt'nnr '��r';�ilr"' Old Republic Surely Company PO Box 1635 Mllwaukoo, WI 5320M635 C®lol7'INUATION CERTIMA k J noimMiamun namnescRwrwr �- W150104719 Building Contractor 5,000.00 1 09/12/2021 09/1212022 Premium Concrete Services, Inc 712 RICHMOND STREET ELICHAR'i', IN 46516 OBLTG�i South Bend -St Joseph County 125 S Lafayette Ste 100 South Bend, IN,46601 ®I�IGINAL FOR BOND RENEWAL_ THIS HDND CONTINUES IN FORCR TO'f}1E ABOVI: B\7'7RA'f10N DASB CONUI'1'IONGD AND PROVB)BD'fHATT4IB LOSSES OR RRCOVBRIR•S ON IT AND ANY AND ALL ENDORSBMBITI S SHALT. NEVER RXCRED THE PISNALTY SBTFORTH IN THU BOND AND WHR7'HBR THE LOSSES OR RBCOVRRIES A" WITHIN 1'118 FIRST ANDIORSURSRQUENTOR IVITHMANY P.XTRNSION OR RBNBWAL PERIOD, PRUSENT, PASTOR FUTURE. ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. SIGN&D ANU DATHD'l'fflS 91h DAY OP June 2021 0465314 GIBSON INSURANCE AGENCY, INC. 202 SOUTH MICHIGAN ST STE 1400 SOUTH BEND, IN 46601 574-245.3500 oRSOPlofi (tf)i) Old Republic Surety Company SUk11Y'Y i� SL�Ar.yi{� A'IT'OIINlY-MPACl' anti r'i<yr hi'citrWYv POWER OF ATTORNEY KNOWAU, MEN BY THESE PRESENTS: That OLD REPUBLIC SURETY COMPANY, a Wisconsin stock Insurance corporation, does make, conslllule and appoint: Elise Faust of Brookfield. WI Its true and lawful Altomey(s)-in-Fact, with full power and authority, not exceeding $10,000,000, for and on behalf of the company as sorely, to execute and deliver and affix the seal of the company ilmm o (If a seal Is required), bonds, undertakings, moogalzances or other written obligations In Ilia nature thereof, (other firm hall bonds, bank depository bonds, mortgage defferancy bonds, mortgage guaranty bonds, guarantees of Installment paper and note guaranty bonds, self lnsdranco worlrers compensation bonds guaranteeing payment of benefits, asbestos abatement contract bonds, waste managementbonds, hazardous waste )'emedriallon bonds orblack lung bonds), as follows: Effective Data: 91'12/202112A0;00 AM Bond Number: W150104719 Bond Amount; rive Thousand Dollars $5,000.00 Principal Name: Premium Concrete Services, Ina Obligoo Name; South Bend -St Joseph County of South Bend, IN and to bind OLD REPUBLIC SURETY COMPANY thereby, and all of the acts of said Atlomeys-in-ract, pursuer)[ to these presents, are ratified and confined. T'hls appointment Is made under and by authority of the board of 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 ilia board of directors of the OLD REPUBLIC SURETY COMPANY on February 19,1982. RESOLVED that Lila president, any vice president or assistant vice president, In conjunction with the secretary or tiny assistant secretary, may appoint attorneys-indacl or agents with authority as defined or limited In (he Instrument evidencing the appointment In each case, tot, and on behalf of the crnnpany to execute and deliver and affix the seal of the company to bonds, undertakings, recogulzances, and suretyship obligations of all kinds, and said officers may remove any such attorney -in -fact or agent and revoke any Power of Attorney previously granted to such person. RESOLVED FURTHER that any bond, undertaking, recognizance, or suretyship obligation shall be valid and binding upon [Ile Company (1) when signed by the president, any vice presidonl of assistant vice president, and attested and sealed (if a seal be required) by any secretary or assistant secretary; or (11) when signed by [he president, any vice presidonl or assistant vice presidonl, secretary or assistant secretary, and counlersigned and sealed (if a seal be required) by a duly authorized attorney -in -fact or agent; or (lit) when duly executed and sealed (if a seal be required) by one or more agorneys-In-fact or agents pursuant to and within the limits of the authority evidenced by the Power of Attorney Issued by the company to such person or persons. RESOLVED FURTHER that the signature of any authorized officer 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 some 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 91h da of June 2,021 affixed fills y 7Jl:tSUjjj... , OLD REPUBLIC 5UR TY COMPANY M1pISEAL Its it U(lt.wslaom �• -�A it lBOOM,, • fijj1 STATE OF WISCONSIN, COUNTY OF WAUICESHA- SS On (iris 9111 day of Julio 202.1 porsonally came before me, „ Alan Pavlic and Karen J. Haffner , to me known to be the Individuals and officers of the OLD REPUBLIC SURETY COMPANY who executed the above instrument, and they each acknowledged the execution of (he same, and being by me duly sworn, dirt severally depose and say: that they are [he said officers of the corporation aforesaid, and that the seal affixed to (lie 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 dlreclois of said corporation. �r,(1',YXR��' ,sy(11bY..11�1�6 `. n +r Worry Public My Commission Expires: 09/28/2022 CERTIFICATE (9xpiroliou of notary's (anruisslon dace list invalidate fills IIIslr iaold) I, the undensigned, assistant secretary of the OLD REPUBLIC SURETY COMPANY, a Wisconsin corporation, CERTIFY that the foregoing and altached Power. o1 AttompW remalas In full force and has not been revoked; and kalhennore, (hat the Resolutions of the board of directors set forth in ilia Power of Attorney, ore nowln force. 0485314 Jy:suuart,,,, /\SIEA•Y,E ' Signed and sealed al the City of Brookfield, WI this _ Bill day of Juno _ , 2021_ On5C 22262 to N) Oe' ,01 Assislapi eeaelery GIBSON INSURANCE AGENCY, INC, INDIANA LABORL+'RY TRAINING TR UST FUND 2)aVfri /t• I7ye Secretary4reasarer Any J. Bolk Chris L. Guerrero Rid y Henson, A. Ramon Mendoza, Jn Danny L. MOO ,O. Box 75t1- Bedrm d, Tndiano d7d21 (812)279-9751 February 23,2(121 '£o Whom It May Concern; Scan Coakley, Direc(ar John K. Bramn Chalrinau IfeJly Abel Mtchael Arnim Stan Meyer Nick Tinmrerman Jim Wiseman FAX: (812)27')�55d5 ['ell Free (800) 742w'1086 This letter is to confiran tbat "Premium Concrete Services, Inc." is a siguatozy conhactor in good standing with the Indiana TLaborers' Tmin ing Trust Fmrd. 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 orir ently eligible to use our apprentices on a project. Further, our s organization'program is approved by ttre US. Veterans Administration to participate in the 01 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) ,tourney workers and thereafter may not employ more that (1) Apprentice for every (3) Journey workers. Si(icerely,, �14 Sean Coakley, Director 5C:jt zvww. tndianalaborershraintng,org Mal � atT }44 MIANA LABORER'S TRASTMC- TRUST FUXD BEDFQRD� TDDTAN9. for the trade classification of CONSTRUCTION GRAFT TABORER fCe�nisterea� as pearf of fie J�ralional �pprer_ficesA2 O J raffraM in accororance ZVA6 %ie aasic slaZ20 ErOrS of apprezzficesfaip esiaUisi eof 6y iAe c3ecrelary of Labor a December 14, 1995,uy SN040-0528 STATE F �NDIAN ❑5 RT&NT OR VETERANS AFFAIRS STATE APPROVING AGENCY 462 VVFST VVASHINGTO14 STREET ROOM W466 NDIANAPOLIS, INDIANA 46204-2736 Jexomy Brewer Fxk�.l>xer[tle ship 'Coox'd nator [iicliamat L�b�re"'s Tra ning'1 ust Fund-Apprenticoship 439 i'atton Hill Rd, Bedford, IN 47421 Eric Holcomb, Governor �JarnesMBrown, Director January 9, 2019 llear 7aremy Brewex> '11is will acknowledge receipt of YOU" revised W red Process" Bedford, or the a The State Appx"ovt ng Laborer program offered at Hoosier Fnexgy, Agency has reviewed the document as listed below: Construction Craft LaUorex' 4,000-7800 hours 4'7-2061.00 FACILITY C())):Gi : 30004114 To the best of my k""owledge Indiana Laborers Traizti"rg Trust Fund-Appzenticesbip does not utilize e"Loneotns or "misleading advotHsement, either by actual statement, omission, or intimation. )t is tmderstood by Indiana Labore",s'Sraining Trust- Fttnd-Appremt reship that they Will maiutaiu a complete recoxd'of all advertising utilized by or on behalf of the company iu regards to thou training programs durkng the pieced ng 12 months. The company's advertising will be available for review by any and all future supervisory visits by the SAA, or the U.S. Department of Veteran Affairs, This approval is made pursnant to and raider the provisions of Title 38, U. S. Code 3687, with an affective date of January 8, 2019. If you have, any questions, please contact me at 317-232-39166 Sincerely, Taniqua Gri'tYin I'xogram Director State Approving Agency Cb:VARO/SLR. PLone (3"7)-234-G062 Toll Free (6U0)-400-4520 Rux (7"7)•234.8744 DEPARTMENT OF VCTEI2AN5 AFFAIRS STATE APPROVING AGENCY 402 WEST WASHINGTON STREET ROOM W-469 INDIANAPOLIS, INDIANA 46204-2738 Jeremy Brower' Apprenticeship Coordinator Indiana Laborers Trataing Trust Fund••Apprenticeship q39 patton hill Rd. Bedford, W 474,21 Dear Joremy Brewer, Erlchlotcomb,:Govenror James M, Brown, Director Jarmary 9, 2019 The Indiana Stat:o Approving Agency conducted a supervisory visit on Ol/8/2019 at Indiana Laborers Training Trust Fund -Apprenticeship, Tlio propose of the visit was to provide b abvng to the Certifying Officials and review enrollment certifications, record retention and reporting procedures. The organization demonstrated proper record inain'tenance 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, Wo 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 Inc directly at tgrlflin@dva.iu.gov or (317) 231•3916. Thanit you for the courtesy extended during my visit, The education and training opportunities that you,' organization continues to provide veterans and their dependents are appreciated. Sutcerely, Taniqua'Gsifth, pr'Ogr'am DlreCtor' phone (31%)••234•GOG2 ToILr+Fee (ft00)-400-4520 Pex (3I7)-234.5'/44 DEPARTMENT OF V✓n7ERANS AFFAIRS ry STATE APPROVING AGENCY 402 WEST WASHINGTON STRFET ROOM W469 INDIANAPOLIS, INDIANA46204.2738 k•. Jorerxxy 13rewei Apprenticeship Coordinator Iadiana Laborers Tyauung'Prtitst F nrd-Appxentiooship 439 Patton hill Rd. Bedford, IN 47421 Erlc Holcomb, Governor _ Jemes M• BBrown, Director Jamiaty 9,?.019 7�eaz Jciemy Brower, This will acknowledge receipt of you updated. age Scale for the Construction Craft Taborer program offered by Indiana Laborers Training Trust Fund•Apprentieeslup.l7xe State Approving Agonoy has reviewed tho document as listed below: Wage Scale: Constr•actlou Craft Taborer FACTLTTiZ COT)S�; 30004114 !atl)ebdsto�rnYlcrrov✓Ledg. - ctiarlaLaboioisTrainingTitrstFundt�pprcnCrcashipdoes:ugtu2ilrzocrro.ne t or inisleading advortisornont; erthor by actual siatErzrcnt, onvssion, or indmat ton, It is rmdCrstood liy Indiana Laborers Training Trust Ftwd•�Apprantioesirip that they will maintain a complete record of all advertising utilized by or on behalf of the Indiana Laborers Train ng Trust Fund-Appronticeslup in regards to their training programs during the preceding 12 months, Indiana Laborers Training Trust Fund-Apprenticesbip`s advertising will be available for review by any and all future supervisory visits by the SAA, or the U.S. Department of Veteran Affairs. Please Review the onth•o packet for: content and accuracy. Approval is granted pursuant to tho provisions of Title 38, U.S. Code 3687, with an effective date of April 1, 2018. If you have any guestious, please feel free to give me a call at 317-232-3 916 or email me at tgriff..m@dva.in,gov, Thank you for what you do for our Veterans, and Iave a great day! Sincerely, r7 , Taniqua Griffin Program Directox State Approving Agency Cc: VARO/BLR 1441 rNorn 9 zp9� Nq �ArrApp2 p�NrG�,i,'y �@pprentiee Sutras Report By indenture Date Apprentices Indonhued Between U1/2020 And 12131/2020 Apprentice Program; IN2 Year Apprentice5tatus Apprentices {'oraenfa�e ,._.,----� q Piloted 'l uesday, Jenuary 17 7.0?.1 '��_ __._ ��� "�" narjo '1O1 1� Apprentice Status Deport by Indenture bate Apprentices Indentured Between 1/1120V And 5113/2020 Apprentice program: IN2 Year Apprentice Status Apprentices Percentage 2017 2018 ApprpnflOG Status Report By Indenture Date Apprentlu0 Indontured Betweon 1/1/2017 And 611312090 ApprenticF, P ograr0l IW2 Year Apprentice 8tatusapprentices Nercentago 2019 Printed: odnosday, May 1'J,'2U2U PlastororcV C;oment Masons' Appronflosship Coordinator Loral Union 11692 To Whom It May Concern: Phone; (219)7III lI I l �rnail: bkristoff@plotnlooal892.org February 26, 202:t This letter is to certify that Premium Concrete SerWces Inc, is and has been a signatory contractor with OPCMIA Local 692 and has participated in the Plasterers 8r Cement Masons Apprenticeship *rraining Program for many years. Premium Concrete Services Inc.is a valued Contractor in good standing with Local 692 and the JATC. All our apprentices are registered with the United States Department of Labor. 1 maybe reached at (2.19j 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. 7ha nl< you, Brian Kristoff Apprentice Coordinator Plasterers & Cement Masons 9200 Louisiana SYroof Morrillvillo, Indiana �46�f10 Kra- �,'-� �(� � ,4 "� ��� <L'.>;.�-:vt�:rla�v' ��� �],.'zi ta-ems.-.�„-yq �i` i$=✓� � `%���^'- icrR 1?ak a�Lp�'r t C( t Y �1 Y i3 °` ril ? Y` r '4�'" -ireytt"" - t +'r--...=a" aU� 's.,C YI s� - Pum C�c A cr Revised:N',Ot`�Ci":lsG-` Premium Concrete Services, Inc 712 Richmond Street EII<hart, IN 46516 574-264-0196 fax 574-266-5392 03/02/2022 To whorr� 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 Premium Concrete Services, Inc. Elkhart, Indiana Annual Report December 31, 2021 Conten#s Report of Independent Accountant on Financial Statement ........................ 1 Financial Statements Statement of Income and Retained Earnings ................................ 2 BalanceSheet................................................................................ 3 Statement of Cash Flows............................................................... 4 Notes to the Financial Statements ................................................. 5 - 8 Supplemental Schedules..................................................... 9 - 10 I Anthony P. Dibley CPA, P.C. 3414 County Road 6 P Elli Indiana 46514 (574) 262-5027 Fax (574) 2644588 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 retalned 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, 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 is not a required part of khe 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. Djkley, CPA, P.C. Elkhart, Indiana February 24, 2022 BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 04/27/2023 Name Zach Hurst Department DPW BPW Date 05/09/2023 Phone Extension 3057 Review and Approval Required Prior to Submittal to Board Diversity Compliance ❑ and Inclusion Officer Officer Name BPW Attorney ❑ Attorney Name Dept. Attorney ❑ Attorney Name Purchasing ❑ Check the Appropriate Item Type — Re uired or All Submissions ❑ Professional Services Agreement ❑ Open Market Contract ® Bid Opening ❑ Quote Opening ❑ Proposal Opening ❑ Chg. Order, No. ❑ Other: ❑ Contract ❑ Proposal ❑ Amendment/Addendum ❑ Special Purchase, QPA ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet ❑ Quote Award ❑ Reject Bids/Quotes ❑ C/O & PCA No. ❑ PCA ❑ Traffic Control ❑ Resolution ❑ Ease./Encroach Reauired Information Company or Vendor Name ❑ Yes[:] If Yes, Approved by Purchasing New Vendor ❑ No Yes MBE MBE/WBE Contractor Completed E-Verify Form Attached ❑ ❑ No Project Name The Hill TIF Project — Site Work Project Number 123-030 Funding Source River West DA TIF Account No. PR-00024021 Amount Terms of Contract Purpose/Description Request to open bids for site work at 511 Notre Dame Avenue, funded through Redevelopment Commission For Chance Orders Onl Amount of ❑ Increase $ ❑ Decrease ($ ) Previous Amount $ Increase Current Percent of Change: Decrease New Amount $ Increase Total Percent of Change: Decrease Time Extension Amount: New Completion Date: