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Home My WebLink AboutOpening of Bids - Monroe Circle Demolition Proj No. 123-048 - Indiana Earth, Inc.CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK Project Name Monroe Circle Demolition Project No. 123-048 For Bids Due May 23, 2023 @ 9:00 A.M. (E.D.T.) via email to BPWbids@southbendin.gov PART I (Must be completed for all bids. Please type or print) Date: Bidder (Firm): IN t— Address: City/State/Zip: IsA Telephone Number: (57q-) 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: Monroe Circle Demolition the City of South Bend, Indiana, in accordance with plans and specifications prepared by: Abonmarche and dated li?�� Z �� for the sum of (enter the Total Bid as shown on the Proposal) ($ (Enter sum of Total Base Bid pl s Alternates shown on Proposal) (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 ne ded, the cost of units must be the same as that shown in the original contract if accepted by the City f uth Be �e bid is to be awarded on a unit basis, the itemization of the units shall be shown �er rate tac t. — By ACCEPTANCE The above bid is accepted this day of Subject to the following conditions: BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Gary A. Gilot, Member Murray L. Miller, Member (Printed Name oT Person Signing) 20 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 Project No. Monroe Circle Demolition 123-048 For Bids Due Tuesday, May 23, 2023 @ 9:00 A.M. (E.D.T.) via email to BPWbids@southbendin.gov 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 executed. Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments f with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and 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 V WBE-2.1]. (` Acknowledge Receipt of 11 Addendum(s) included with the bid. i0 All required additional information is included with the bid. Proposal statements and other affidavits all signed by the proper party with name either printed or typed underneath signature. This checklist submitted with the Bid. This checklist is provided for bidder's use in assuring compliance with required documentation; however, it does not include all specifications requirements and does not relieve the bidder of the need to read and comply with the specifications. Bidder: I�� b'�'�}'�.— Date: �� 7j�✓ �� 1.11 i r1 By Authorized Representative; Signature: Print Name & Title: Version 09/29/2021 Contractor's Bid for Public Works - 1 PART II (For 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 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. 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 INDIANA EARTH, INC. 10343 MCKINLEY HWY OSCEOLA, IN 46561 Section 1 Public Projects completed: 1) Demo, Excavation and Utility — Laporte County Courthouse 2) Excavation and Utility — Penn Township Fire Station 3) Excavation and Utility — Knox Community Schools 4) Excavation and Utility — Nappanee Water Main Replacement 5) Excavation and Demolition — Mishawaka City Hall 6) Excavation and Utility — Ironworks Plaza Phase 3 7) Excavation and Utility —Topeka Water Treatment Plant 8) Building and Site Development —Argos Downtown Square Public Works in Process: 1) Excavation and Utility— LaGrange INDOT Unit Building 2) Excavation — Elkhart County Courthouse Completed all work awarded to our firm. References of Private Firms 1) Weis Builders 2) FCI Construction 3) Gibson Lewis LLC 4) Larson Danielson 5) Robert Henry Const. 773-304-4600 260-927-8516 574-259-8581 219-362-2127 574-232-2091 Section 2 Plan of proposed work 1) Per Spec 2) Secure site with 6' fence 3) Security service 4) Demolish buildings and haul debris away 5) Remove utilities 6) Topsoil and Hydro -seed 7) Site restoration per plan $700,000 Summer 2021 $260,000 Summer 2021 $150,000 Summer 2022 $3,100,000 2022 $200,000 Summer 2022 $500,000 Summer 2022 $500,000 Summer 2022 $1,000,000 Summer 2022 $1,000,000 Winter 2023 $150,000 Spring 2024 Subcontractors Utilized on Past Projects 1) Weaver Boos —South Bend, IN, Compaction Testing 2) Acorn Landscaping — IUSB West Parking Lot 3) Abonmarche — South Bend, IN, Surveying 4) Rieth Riley —Goshen, IN, Paving 5) Hawk Electric — Merrillville, IN Subcontractors to Utilize on this Project — Possible subs listed, will determine prior to contract approval 1) Contractors to be determined to include trucking, security, dumpsters and for restoration List of our Equipment Owned: 1) 29 Excavators 2) 6 Dozers 3) 27 Dump Trucks 4) 2 Semi Trucks with dump trailers 5) 6 Rollers 6) 6 Loaders 7) 6 Skidsteers 8) 2 Off Road Haul Trucks 9) 2 Man Lifts 10) 1 Vermeer Vac Truck 11) Eagle Crusher We have received pricing for services and materials by potential subcontractors. 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: 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 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 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. 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 Version 09/29/2021 Contractor's Bid for Public Works - 5 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 NI,4f 202-3 Contract 1 ler Fi Signature of Contractor/Bidde r Its Agent Printed Name and Title Subscribed and sworn to before me this day of lc: , 20�;O My Commission Expires " c%' < c1 F ati 1w—L oL9i L\�� Notary Public County of Residence`' ROXANNE LAURENE ALFORD ;��o P •Gee'' Notary Public, State of Indiana = .:SEALE St. Joseph County i • ;'+ .: ; Commission Number NP0741524 My Commission 203xpires Version 09/29/2021 Contractor's Bid for Public Works - 6 BID/PROPOSAL CITY OF SOUTH BEND Project Name: Monroe Circle Demolition Project Number: 123-048 For Bids Due Contractor Name BASE BID Tuesday, May 9, 2023 @ 9:00 A.M. (E.D.T.) via email to BPWbids@southbendin.gov 1q(%1,-hl��,c� Item Description Quantity Unit Unit Price Total Amount No. 1 Demolition of 17 Buildings, Site with 1 LSUM Utilities and Appurtenances 1 BASE BID TOTAL ALTERNATE #1 Item Description Quantity Unit Unit Price Total Amount No. 1 Demolition of Monroe Circle Right of 1 LSUM `� �'-7, •�� Wayand Appurtenances 1� ALTERNATE #1 TOTAL 3c;�..�- BASE BID PLUS ALTERNATE #1 TOTAL Bidder (Firm): I I•l �'�� -} ) rL C — Address: City/State/ZipTelephone Number: By F' (Signature) ��L��" (Printed Name of Person Signing) Version 09/2912021 Contractor's Bid for Public Works - 7 aiurr;, CITY OF SOUTH BEND r MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN = FORM MBE-1.0 MBE UTILIZATION PLAN This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MBE participation. It is the bidder's sole responsibility to verify whether any listed minority -owned business meets the MBE qualifications. Project Number: Bidder: 123-048 Project Name Monroe Circle Demolition l r�l�rr'�t'�iLf`=�i I li� ✓ Total Bid Amount: MBE Goal: 1.4% Page of Name & Address of MBE Primary Contact Person (Name/Telephone) Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of MBE Component Percentage of Total Bid/Proposal 1?'C%'—K-tcu? (i"_` u�� -7'r Fl-'iRA At 4v v � l0 ;MIS Submitted by: Print Name Signature Date Version 09/29/2021 Contractor's Bid for Public Works - 8 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: Bidder: 123-048 Project Name: Monroe Circle Demolition c_-A-�z"`ri Total Bid Amount: �,. � � � %�: j WBE Goal: 4.7% Page__L_of t' Name & Address of WBE Primary Contact Person Scope of Work to be Performed Dollar Amount of WBE Percentage of Total (Name/Telephone) (Attach scope/schedule if you need additional space) Component Bid/Proposal f -{��`% Z%l-7 Submitted by: MA , &Su�a iIi��1 j��lti�� 5 Z— 3 Print Name ignature Date Version 09/29/2021 Contractor's Bid for Public Works - 9 CITY OF SOUTH BEND . MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE-2.0 =i 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: 123-048 Project Name: Monroe Circle Demolition Date: Bidder: N CIft Contact Person: e, ww <ss Telephone: Address: jv�l`� mce-tal-gy N'Uiy City: L111V State: Zip:I Email: IVtc- S :,y(tAkA Ke_+ 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: http://www.in.gov oa . 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 MWBEs, including, where appropriate, breaking out contract work items into economically feasible units to facilitate MBE participation. I affirm that I have made good faith efforts to solicit through all reasonable and available means the interest of all MBEs in the scopes of work of the contract. I affirm that I attended all pre -bid meetings scheduled by the City of South Bend to inform MBEs of contracting and subcontracting opportunities. I affirm that I advertised in general circulation and/or trade association publications concerning subcontract opportunities and allowed MBEs reasonable time to respond to such advertisements. I affirm that I performed any and all necessary steps to provide written notices in a manner reasonably calculated to inform MBEs of subcontracting opportunities and allowed sufficient time for MBEs to participate effectively. S 1 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 MBE-2.0 EVIDENCE OF GOOD FAITH EFFORTS �` c � I affirm that I have made good faith efforts to assist interested MBEs in obtaining necessary equipment, supplies, materials, or related assistances or services, where appropriate. I affirm that I did not reject any MBEs as unqualified without sound business reasons based 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 l: 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 MWBE participation. Project Number: 123-048 Project Name: Bidder: Contact Person Address: Monroe Circle Demolition Date: _S;—7? —Z`?--3 N61,1714-A— i2�_-4 V 1 �' i— �tTZZf�1lt-S Telephone:7y—L=j—��j City: a$Cl State: j Zip:��/ Email: A� '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.ggydqggL/. 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 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. I affirm that I followed up on initial solicitations with interested WBEs. I affirm that I negotiated with interested WBEs in good faith, including providing such WBEs k,7 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, Pr 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 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. �7 I affirm that I did not reject any WBEs as unqualified without sound business reasons based on a thorough investigation of their capabilities. CONTRACT RECORDS: The bidder has maintained the following records for each WBE that has bid on the subcontracting opportunity: 1. Name, address, and telephone number; 2. A description of information provided by the bidder or subcontractor; and 3. A statement of whether an agreement was reached, and if not, why not, including any reasons for concluding that the MWBE was unqualified to perform the job. ' Proper demonstration of Good Faith Efforts requires your initials next to all of the above boxes. Any omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of South Bend reserves the right to request additional information. Version 09/29/2021 Contractor's Bid for Public Works - 13 �J 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 -owned business meets the MBE qualifications. Attach additional pages if necessary. PAGEOF Project Number: 123-048 Project Name: Monroe Circle Demolition MBE Firm (�r Owner or Contact at MBE Firm �� Telephone: 57 ��`!�; -) Fax: TYPE OF WORK SOLICITED FOR THIS PROJECT MBE Participation Goal Email: 1.4% RESULTS OF CONTACT WITH THE MBE FIRM: �� 1il-C~� �? �-iGl,✓`2i 1 C� T'�� Si�� '�ti�C�'�� l� >�/[�-l1'�� i�' ��Y�! MBE Firm�-- Owner or Contact at MBE Firm LanyW.,f -/L., Telephone: 7 jc C7S/_ 9-If 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 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 -owned business meets the MBE qualifications. Attach additional pages if necessary. PAGE _-7— OF Project Number: 123-048 Project Name: Bidder: By: (Signature) Monroe Circle Demolition (Title) MBE Participation Goal MBE Firm P1 -JJt-n? Owner or Contact at MBE Firm Telephone: 2 1,1_ 723 ,, `j 3�,:7 Fax: TYPE OF WORK SOLICITED FOR THIS PROJECT: Email: RESULTS OF CONTACT WITH THE MBE FIRM: MBE Firm ��Tji-�?�!/� ��Ll��-L�✓1��"L� Owner or Contact at MBE Firm Telephoner 9y_12(,�0_1119-1 Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: /,? U/ RESULTS OF CONTACT WITH THE MBE FIRM: (Date) 1.4% Version 09/29/2021 Contractor's Bid for Public Works - 14 CITY OF SOUTH BEND, MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE-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. i PAGE I OF 1 Project Number: 123-048 Project Name: Monroe Circle Demolition Bidder: 1311 / y P, la WBE Participation Goal 4.7% (Signature) l (Title) (Date) WBE Firm f�1'Lrd'�1U7'`frJ- Owner or Contact at WBE Firm Telephone: t;p_ ?Z- ?.2,L,272_ Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE WBE FIRM: WBE Firm Owner or Contact at WBE Firm Telephone: L17 Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE WBE FIRM: Version 09/29/2021 Contractor's Bid for Public Works - 15 CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK RESPONSIBLE BIDDER CHECKLIST Project Name Monroe Circle Demolition Project No. 123-048 For Bids Due Tuesday, May 23, 2023 @ 9:00 A.M. (E.D.T.) via email to BPWbids@southbendin.gov Contractor Name: 0)111 1-rtq�l The City seeks to enhance its ability to identify responsive and responsible bidders on all City public works projects by institution of comprehensive submission requirements in compliance with State law. Quality workmanship, efficient operation, safety, and timely completion of projects requires that all bidders meet certain minimum requirements to be responsive and responsible bidders. THIS FORM MUST BE SUBMITTED WITH YOUR BID. INSTRUCTIONS: If you are a pre -qualified bidder, complete Section I only. If you are not a pre -qualified bidder, complete Section II only. Section II acts as an application for pre -qualification. Submission of Section II will allow the bidder to be considered for pre -qualification for bids with the City of South Bend Department of Public Works. Pre - qualified bidders will then be exempt from a portion of the submission requirements outlined in Section 6- 63 of The Responsible Bidding Ordinance No. 10594-18 (hereinafter, "Responsible Bidding Ordinance") for a period of twelve (12) months. Thereafter, contractors who are pre -qualified must submit a complete application for continuation of "pre - qualified" standing, on a form provided by the City ("Responsible Bidder Checklist (1) Pre -Qualified Bidders") by December 315' 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, tough 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. J 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: (i) _ By checking this box, I hereby acknowledge that I am a pre -qualified bidder with the City of South Bend and that I have met the pre -qualification requirements within the last twelve (12) months. A copy of my Pre -Qualification verification letter is attached. 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). 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. 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 PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED) (a) Acknowledgements: (i) By checking this box, I hereby acknowledge that I am not a pre -qualified bidder with the City of South Bend. By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided, and may also conduct random inquiries of my current and prior customers. The City reserved the right to utilize all information provided in this submission and all information obtained in inquiries or requests to determine if a bidder is responsive and responsible. Additionally, I acknowledge that all information provided to the City shall be regarded as public records. By checking this box, I hereby acknowledge that copies of all Applicable apprenticeship certificates or standards for training programs applicable to the work performed on the project may be requested at any time and shall be furnished upon request. (iv) _✓ By checking this box, I hereby acknowledge and ensure that I and all sub- contractors, from whom I have accepted a bid and/or intend to hire to perform work on the public work project, are properly licensed. Furthermore, I acknowledge my understanding that it is my responsibility to ensure that all sub -contractors have the necessary licenses to undertake the work called for in this bid. If a sub- contractor loses their license at any point, it is the responsibility of that sub- contractor to notify the City. (b) Attachments: (i) Indiana Secretary of State's on-line records (ie. Business verification) dated within sixty (60) days of the submission of said document showing that business is in existence, current with the Indiana Secretary of State's Business Entity Report, and eligible for a certificate of good standing. (Not applicable to individuals, sole ✓ proprietors or partnerships). (ii) List identifying all former business names. ffbly✓,; (iii) ri 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) r/ 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) Evidence that I am utilizing a surety company which is on the Bureau of Fiscal Service "Department of Treasury's Listing of Approved Sureties" as required in the bid specifications or contract. Version 02/23/2022 General Conditions - 13 (ix) 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) P/ 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. (Print Name Here) (Name of Company) (Address of Company) (City) kv, (State) 74- q-' (Telephone Number) Version 02/23/2022 General Conditions - 14 BUSINESS INFORMATION DIEGO MORALES INDIANA SECRETARY OF STATE 05/23/2023 08:35 AM Business Details Business Name: INDIANA EARTH, INC. Business ID: 1990031137 Entity Type: Domestic For -Profit Corporation Business Status: Active Creation Date: 03/22/1990 Inactive Date: 10343 MCKINLEY HWY., OSCEOLA, IN, Principal Office Address: 46561 - 9756, USA Expiration Date: Perpetual Jurisdiction of Formation: Indiana Business Entity Report Due 03/31/2024 Date: Years Due: Governing Person Information Title Name Address President MARK L OSLER 10343 McKinley Hwy., Osceola, IN, 46561, USA Registered Agent Information Type: Individual Name: MARK OSLER Address: 10343 MCKINLEY IIVVY., OSCEOLA, IN, 46561- 9756, USA l N V (11-Kk C4-V�fW, rah Building Pre -qualification checklist items: • Indiana Earth, INC has no former business names. • Indiana Earth, INC has had no determinations by a governmental agency of any violations. • Indiana Earth has the crew and staff to complete this project. • Indiana Earth partners with the local 150 operators union and the local labors union for training and apprentices. • Those that work on this project will be employees of Indiana Earth or of a hired subcontractor which are under all applicable state and federal laws and local ordinances. • Operators and Laborers drug screening are through the BCRC Building Construction Resource Center at BCRCNET.com. • Teamster's drug screening are performed during pre -employment and by random through Figment Group with quarterly random requirements. • Indiana Earth, INC has no current tax liens. • Projects similar to this one. o Nappanee Waste Water Treatment Plant o St Mary's College o Laporte Intermediate School o Concord High school o Penn High School o Central Park in Mishawaka o Toll Road Plazas of Howe, IN o Toll Road Plazas of Elkhart, IN o Penn High School o Howard Park o Toll Rd Administration Building o Kalamazoo Natatorium Demo o Western Ave o Eagleway Sewer Extension o Knox Community Schools o Nappanee Water Main Replacement o LaPorte County Courthouse o New Buffalo Fire Station o Penn Township Fire Station • All subcontractors working for Indiana Earth are qualified under EC 4-13.4 or IC 8-23-10 5/23/23, 8:43 AM Surety Bonds - List of Certified Companies Swiss Re Corporate Solutions America Insurance Corporations (NAIC #29874) BUSINESS ADDRESS: 1200 MAIN ST. SUITE 800, KANSAS CITY, MO 64105 - 2478. PHONE: (816) 235-3700. UNDERWRITING LIMITATION b/: $95,164,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Missouri. https://www.fiscal.treasury.gov/surety-bonds/list-certified-companies.html#s 1l1 Date: May 18, 2023 To: All Planholders From Theresa Heffner, Clerk, Board of Public Works Subject Addendum Number: 1 Project Name Monroe Circle Demolition Project Number: 123-048 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: r 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. 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: Authorized Si Date: Version 8/11/2020 Document �� 3 `� TM - 2010 Bid Bond CONTRACTOR: SURETY: (Name, legal status and address) (Name, legal status and principal place Indiana Earth, Inc. of business) Swiss Re Corporate Solutions America Insur nce Cor oration 10343 McKinley Highway 1200 Main Street Suite 800 Whis document has important legal Osceola, IN 46561 Kansas City, MO 64105 consequences. Consultation with OWNER: an attorney is encouraged with (Name, legal status and address) respect to its completion or modification. City of South Bend 227 West Jefferson Boulevard South Bend, IN 46601 BOND AMOUNT: ***FIVE PERCENT OF AMOUNT BID*** PROJECT: (Nrnne, location or address, and Project number if any) Monroe Circle Apartment Demolition - #123-048 Any singular reference to Contractor, Surety, Owner or other party shall be considered plural where applicable. The Contractor 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 heirs, executors, administrators, successors and assigns, jointly and severally, as provided herein. The conditions of this Bond are such that if the Owner accepts the bid of the Contractor within the time specified in the bid documents, or within such time period as may be agreed to by the Owner and Contractor, and the Contractor either (1) enters into a contract with the Owner in accordance with the terms of such bid, and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a surety admitted in the jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof; or (2) pays to the Owner the difference, not to exceed the amount of this Bond, between the amount specified in said bid and such larger amount for which the Owner may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. The Surety hereby waives any notice of an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for an extension beyond sixty (60) days. If this Bond is issued in connection with a subcontractor's bid to a Contractor, the tern 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 confl�rrn ng to such sta tory or other legal requirement shall be deemed incorporated herein. When so furnished, the intent is that this B d shall be construed as a statutory bond an not as a c on w ond. Signed an eated this rd day of May 0 Indian iy� �yvv (Principal) (Seal) (With ss) (Title) Swiss Re C94porate Solutions America Insurance corporation (Surety) (6f/itn s) (Title) - Thomas O. Chambers. Attornev-in-Fact AIA Document A310T" — 2010. Copyright C 1963, 1970 and 2010 by The American Institute of Architects. All rights reserved. WARNING: This Ate Init. Document Is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA® Doc iloent, c? any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible undvrthe law. / Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright@aia.org. osnio SWISS RE CORPORATE SOLUTIONS SWiSS RE CORPORATE SOLUTIONS AMERICA INSURANCE CORPORATION ("SRCSAIC") SWISS RE CORPORATE SOLUTIONS PREMIER INSURANCE CORPORATION ("SRCSPIC") WESTPORT INSURANCE CORPORATION ("WIC") GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS, THAT SRCSAIC, a corporation duly organized and existing under laws of the State of Missouri, and having its principal office in the City of Kansas City, Missouri, and SRCSPIC, a corporation organized and existing under the laws of the State of Missouri and having its principal office in the City of Kansas City, Missouri, and WIC, organized under the laws of the State of Missouri, and having its principal office in the City of Kansas City, Missouri, each does hereby make, constitute and appoint: THOMAS O. CHAMBERS, TODD SCHAAP. KIMBERLY S. RASCH, and PAUL JACOBSEN JOINTLY OR SEVERALLY Its true and lawful Attorney(s)-in-Fact, to snake, execute, seal and deliver, for and on its behalf and as its act and deed, bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies, as surety, on contracts of suretyship as are or may be required or permitted by law, regulation, contract or otherwise, provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of: UNLIMITED This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of both SRCSAIC and SRCSPIC at meetings duly called and held on the 18th of November 2021 and WIC by written consent of its Executive Committee dated July 18, 2011. "RESOLVED, that any two of the President, any Managing Director, any Senior Vice President, any Vice President, the Secretary or any Assistant Secretary be, and each or any of them hereby is, authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Corporation bonds, undertakings and all contracts of surety, and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Corporation: and it is FURTHER RESOLVED, that the signature of such officers and the seal of the Corporation may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Corporation when so affixed and in the future with regard to anv bond, undertaking or contract of surety to which it is attached" PREti �RFORgT�tya y ,,.....,,y SEAL Erik Jutssem, Senior Vice President of SRCSAIC & Sen or Vice President n : = of SRCSPIC &Senior Vice President ofWIC r :0J •• � �� 4 s,1 ��.e, T��BSrr k!SSOU �\ydl•�.' gv "!S s�'s�.``�� Gerald Jagrowski. Vice President orSRCSAIC & Vice President of SRCSPIC & Vice President of WIC IN WITNESS WHEREOF, SRCSAIC, SRCSPIC, and WIC have caused their official seals to be hereunto affixed, and these presents to be signed by their authorized officers this 10 day of NOVEMBER ,0 22 Swiss Re Corporate Solutions America Insurance Corporation State of Illinois Swiss Re Corporate Solutions Premier Insurance Corporation County of Cook ElWestport Insurance Corporation On this 10 day of NOVEMBER , 20 22 . before me, a Notary Public personally appeared Erik Janssens , Senior Vice President of SRCSAIC and Senior Vice President of SRCSPIC and Senior Vice President of WIC and Gerald Jagrowski , Vice President of SRCSAIC and Vice President of SPCSPIC and Vice President of WIC, personally known to me, who being by me duly sworn, acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed of their respective companies. OFFICIAL SEAL CHRISTiNA MANISCO E>mM►terti � � �p � �i6I�1�Qn�['L 1, Jeffrey Goldberg, the duly elected Senior Vice President and Assisi_dnt Secretary of SRCSAIC and SRCSPIC and WIC:, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney riven by said SRCSAIC and SRCSPIC and WIC, which is sti11 in full force and effect. IN WITNESS WHEREOF, I have set my hand and affixed the sculs 5f the Companies this23rd day of May , 2023. Jeffrey Goldberg, Senior Vice President &s Assistant Secretary of SRCSAIC and SRCSPIC and WIC STATE OF WISCONSIN ) COUNTY OF Kenosha ) ON THIS 23rd day of May 2023 , before me, a notary public, within and for said County and State, personally appeared Thomas O. Chambers to me personally known, who being duly sworn, upon oath did say that he is the Attorney -in -Fact of and for the Swiss Re Corporate Solutions America Insurance Corporation , a corporation of Missouri , created, organized and existing under and by virtue of the laws of the State of Missouri ; that the corporate seal affixed to the foregoing within instrument is the seal of the said Company; that the seal was affixed and the said instrument was executed by authority of its Board of Directors; and the said Thomas O. Chambers did acknowledge that he/she executed the said instrument as the free act and deed of said Company. .1 Kimberl S. Rasch Notary Public, Kenosha County, Wisconsin My Commission Expires 1/{Y0i26�r,� `Puevvp ' QF WN�•�`�•