HomeMy WebLinkAboutOpening of Bids - West Race Gate Repair Proj No. 122-063 - Milestone Contractors North, Inc.CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
Project Name
Project No.
For Bids Due
West Race Gate Repair
122-063
MAY 23, 2023
PART I
(Must be completed for all bids. Please type or print)
Date: 5/23/2023 Bidder (Firm): Milestone Contractors North, Inc.
Address: 24358 SR 23
City/State/Zip: South Bend. IN 46614 Telephone Number: ( 574 ) 288-4811
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:
West Race Gate Repair
the City of South Bend, Indiana, in accordance with plans and specifications prepared by:
Lawson Fisher Associates
and dated 4/28/2023 _ _ for the sum of (enter the Total Bid as shown on the Proposal)
Six hundred thirty two thousand three hundred sixteen dollars and zero cents 632,316.00 _
(Enter sum of Total Base Bid plus 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 its a proposal for each in accordance
with the notice. Any addendums attached will be specificall fer ced at the applicable page.
If additional units of material included in the contract are ede , the gnt of units must be the same as that
shown in the original contract if accepted by the City Soyth Be . If the is"to be awarded on a unit
basis, the itemization of the units shall be shown o se rate o0chmefit.
By
The above bid is accepted this
Subject to the following conditions:
BOARD OF PUBLIC WORKS
Elizabeth A. Maradik, President
Gary A. Gilot, Member
XuMin P. Hilary, Director of Estimating
(Printed Name of Person Signing)
ACCEPTANCE
day of
20
Joseph R. Molnar, Vice President
Jordan V. Gathers, Member
Murray L. Miller, Member Attest: Theresa Heffner, Clerk
Version 09/29/2021 Contractor's Bid for Public Works - 2
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
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
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 Indiana )
) SS:
St. Joseph 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 23rd day of . May , 20 23
`��ttttiiil/i�i
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of Contractor/Bidder or Its Agent
Dustin P. Hilary, Director of Estimating
Printed Name and Title
Subscribed and sworn to before me this 23rd day of Mav 20 23
My Commission Expires 6/5/2030 1 ' iL�
Notary Pu 1,ic Alisha Kru r
County of Residence LaPorte
ALISHA FUEGER
MYCommissionExpites
=* SEAL *`
June 5,2030
Commission Number NPW53544
La Porte County
Version 09/29/2021 Contractor's Bid for Public Works - 6
BID/PROPOSAL
CITY OF SOUTH BEND
Project Name: West Race Gate Repair
Proiect Number: 115-155
For Bids Due: May 23rd, 2023
Contractor Name: Milestone Contractors North. Inc.
4
ems`
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
1
Construction Engineering
1
LSUM
$ 3,500.00
$ 3,500.00
2
Mobilization and Demobilization
1
LSUM
$ 31,500.00
$ 31,500.00
3
Clearing Right -of -Way
1
LSUM
$ 135,000.00
$ 135,000.00
4
Present Structure, Remove Portions
1
LSUM
$ 23,000.00
$ 23,000.00
5
Dewatering
1
LSUM
$ 242,000.00
$ 242,000.00
6
Reinforcing Bars, Epoxy Coated
5,218
LBS
$ 3.00
$ 15,654.00
7
Concrete, Class C
27
CYS
$ 2,200.00
$ 59,400.00
8
Field Drilled Hole in Concrete
122
EACH
$ 15.00
$ 1,830.00
9
Patching Concrete Structures
200
SFT
$ 200.00
$ 40,000.00
10
11/ Aluminum Handrail
65
LFT
$ 220.00
$ 14,300.00
11
Aluminum Slide Gate (sluice gate)
1
EACH
$ 20,000.00
$ 20,000.00
12
Waterstop (strip)
50
LFT
$ 20.00
$ 1,000.00
13
Structural Steel, Galvanized, Grade 50
372
LBS
$ 30.00
$ 11,160.00
14
Structural Steel, Galvanized, Grade 36
564
LBS
$ 28.00
$ 15,792.00
15
Steel Bar Grating, 1 1/2" x 3/16", Galvanized
112
SFT
$ 140.00
$ 15,680.00
16
Maintaining Traffic
1
LSUM
$ 2,500.00
$ 2,500.00
Bidder (Firm):
Milestone Contrac
Address: 24358 SR 23
City/State/Zip: South Bend. IN 46614 Telephone Number:
By
BID TOTAL 1 $ 632,316.00
(Signature)
Z--Dustin P. Hilary, Director of Estimating
(Printed Name of Person Signing)
Version 09/29/2021 Contractors Bid for Public Works - 7
A (Revised By Addendum No. 1 — 5/18/23)
CITY OF SOUTH BEND
J
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-1.0 ,ate
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:
122-063 Project Name: West Race Gate Repair
Milestone Contractors North, Inc. Total Bid Amount: $632,316.00
MBE Goal: N/A
Page_WA A of N/A
Primary Contact Person
Name & Address of MBE (Name/Telephone)
Scope of Work to be Performed
(Attach scope/schedule if you need additional space)
Dollar Amount of MBE
Component
Percentage
of Total
Bid/Proposal
N/A
Submitted by: Dustin P. Hilary, Director of Estime
Print Name
Version 09/29/2021 Contractor's Bid for Public Works - 8
5/23/2023
Date
CITY OF SOUTH BEND --
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN �$
FORM WBE-1.0'
WBE UTILIZATION PLAN
8
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving WBE participation. It is
the bidder's sole responsibility to verify whether any listed woman -owned business meets the WBE qualifications.
Project Number: 122-063 Project Name:
West Race Gate Repair
Bidder: Milestone Contractors North, Inc.
Total Bid Amount: $632,316.00
WBE Goal:
N/A
Page 1
of 1
Primary Contact Person
Name & Address of WBE
Scope of Work to be Performed
of WBE
Percentage
of TotalPollarAmount
(NametTelephone)
(Attach scope/schedule if you need additional space)
Component
Bid/Proposal
NONE
Submitted by: Dustin P. Hilary, Director of Estimating
Print Name
Version 09/29/2021 Contractor's Bid for Public Works - 9
5/23/2023
Date
CITY OF SOUTH BEND v
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.0
EVIDENCE OF GOOD FAITH EFFORTS
This completed form should be included as part of the Bids documents related to City of South Bend Public
Works Projects requiring Good Faith Efforts to obtain MBE participation.
Project Number: 122-063
Project Name: West Race Gate Repair
Bidder: Milestone Contractors North, Inc.
Contact Person:
Address:
Carl Tu
24358 SR 23
City: South Bend state: indiana
Date: 5/23/2023
Telephone: 574-288-4811
zip: 46614
Email: ctungate(Mmilestonelp.com
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: httq://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
(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.
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
Th
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN ' W
FORM MBE-2.0 „
EVIDENCE OF GOOD FAITH EFFORTS
I affirm that I have made good faith efforts to assist interested MBEs in obtaining necessary
equipment, supplies, materials, or related assistances or services, where appropriate.
I affirm that I did not reject any MBEs as unqualified without sound business reasons based
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
Spl1TH
CITY OF SOUTH BEND _
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM WBE-2.0 is 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 MWBE participation.
Project Number: 122-063 Date: 5/23/2023
Project Name: West Race Gate Repair
Bidder: Milestone Contractors North, Inc.
Contact Person: Carl Tun ate _ Telephone: 574-288-4811
Address: 24358 SR 23
City: South Bend State: Indiana zip: 46614
Email: ctungate@milestonelp.com
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• httn-//www in nnv/idea/
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
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
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
necessary equipment
appropriate.
made good faith efforts to assist interested WBEs in obtaining
supplies, materials, or related assistances or services, where
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
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 1 OF
Project Number: 122-063 MBE Participation Goal N/A
Project Name: st Race Gate Rspair
Bidder: Mil t
By: — , Z,/- ,
North, Inc.
I
> Dustin P. Hilary (Title)
Z
'rmNONE
ner or Contact at MBE Firm
Telephone: Fax: Email:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OF CONTACT WITH THE MBE FIRM:
MBE Firm NONE
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
CITY OF SOUTH BEND v
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN_
FORM MBE-2.1s:
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 1 OF
Project Number: _ l?,4063 WBE Participation Goal N/A
Project Nam
Bidder:
By:
Gate
r
Director of Estimati
( ature) Dustin P. Hilary (Title) (Date)
Firm NONE
Owner or Contact at WBE Firm
Telephone: Fax: Email:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OF CONTACT WITH THE WBE FIRM:
WBE Firm NONE
Owner or Contact at WBE Firm
Telephone: 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
Bid Bond
CONTRACTOR:
(Name, legal status and address)
Milestone Contractors North, Inc.
24358 State Road 23
South Bend, IN 46614
OWNER:
(Name, legal status and address)
CNA S RG ! #
Bond No. Bid Bond
SURETY: Continental Casualty Company
(Name, legal status and principal place
of business)
151 N. Franklin Street
17th Floor
Chicago, IL 60606
City of South Bend
227 West Jefferson Blvd.
South Bend, IN 46601
BOND AMOUNT: 5% Five Percent of the Base Bid Plus Any Alternates
PROJECT:
(Name, location or address, and Project number, if any)
West Race Gate Repair; Project No. 122-063
This document has Important legal
consequences. Consultation with
an attorney is encouraged with
respect to its completion or
modification.
Any singular reference to
Contractor, Surety, Owner or
other party shall be considered
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 term Contractor in this Bond shall
be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor.
``�1111111//���,'
When this Bond has been furnished to comply with a statutory or other legal requirement in the location q,'tiie� i
�
any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted b and"''•.;
provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein�n�W p RArF :Ile
furnished, the intent is that this Bond shall be construed as a statutory bonyand as a common lawSoUcl.Signed and sealed this _ 23rd day of _ May (U:Milesto o c.
Mil
Mr,
(Witness) Alisha Krueger g
ustin R Hilary, Director of Estimatin �
ntinental Casu Company' anlIaoagre
(Wit ss) Andrew A. Lanphere By:
(Title) Angel . Riley, Attorney -in -Fact
f sg7 t, •
�o
Printed in cooperation with the American Institute of Architects (AIA).
The language In this document conforms to the language used In AIA Document A310 - Bid Bond - 2010 Edition.
Date: May 18, 2023
To: All Planholders
From Theresa Heffner, Clerk, Board of Public Works
Subject Addendum Number: 1
Project Name: West Race Gate Repair
Project Number: 122-063
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM
Date Received: 5/23/2023
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 herey.r,
Company: Milestone Cont�orxgor, Inc.
Authorized Signature:
Date: 5/23/2023
Version 8/11/2020
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
CHECKLIST FOR BIDDERS
Project Name
Project No.
For Bids Due
West Race Gate Repair
122-063
MAY 23, 2023
From time to time the South Bend Board of Public Works finds it necessary to reject a bid because
it does not comply with statutory requirements. In preparing your bid, please use the following
checklist in order to make sure that your bid is done in the proper manner.
Proper bid security included. The bidder has the option of providing either a Certified Check
X or Bid Bond.
Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely
X executed.
Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments
with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and
X 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
X WBE-2.1].
X Acknowledge Receipt of 1 Addendum(s) included with the bid.
X All required additional information is included with the bid.
Proposal statements and other affidavits all signed by the proper party with name either
X printed or typed underneath signature.
X 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-ond comply with the specifications.
Bidder: Milestone Contra
By Authorized
Signature:
Print Name & Title, Dj,�tin P. Hilary, Director of Estimatin
Version 09/29/2021 Contractor's Bid for Public Works -1
Date: 5/23/2023
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
RESPONSIBLE BIDDER CHECKLIST
Project Name West Race Gate Repair
Project No. 122-063
For Bids Due MAY 23, 2023
Contractor Name: Milestone Contractors North, Inc.
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. 10694-18 (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 31 s' 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:
(i) X By checking this box, I hereby acknowledge that I am a pre -qualified bidder with
the City of South Bend and that I have met the pre -qualification requirements within
the last twelve (12) months. A copy of my Pre -Qualification verification letter
is attached.
(ii) X 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) X 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) X 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) X 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) X 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.
(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 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.
(iii) _
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) _
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) _ 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.
ivmesione uonvaciors iNortn. inc.
(Name of Company)
24358 SR 23
(Address of Company)
South Bend
(City)
Indiana
(State)
574-288-4811
(Telephone Number)
Version 02/23/2022 General Conditions - 14
Responsible Bidding Practices and Submission
Requirements for Pre -Qualified Bidder Checklist
(b) Attachments
(i) Attached
Staffing Capabilities: Milestone Contractors North, Inc. is signatory with the
following unions which supply our workforce — Laborers International Union,
Teamsters, Operating Engineers and Cement Masons.
(iii) See Forms 96 and 96a
(iv) All individuals who will perform worn on the public works project on behalf of
Milestone Contractors North, Inc. will be properly classified under applicable state
and federal laws and local ordinances.
Dated: Mai: 23rd.2023
P. Hilary, Director of Estimating
CITY OF SOUTH BEND JAWS MUELLER, MAYOR
DEPARTMENT OF PUBLIC WORKS
ERIC HORVATH, DIRECTOR
November 18, 2022
Alisha Krueger
Milestone Contractors North, Inc.
akrue erp,milestonel .com
RE: Pre -Qualification Verification
Dear Ms. Krueger:
This letter serves as verification of Pre -Qualification status of your company for bidding
with the City of South Bend. This Pre -Qualification status is effective for twelve (12)
months from the date of this letter. Thereafter you are required to re -submit a complete
application for continuation of pre -qualification status prior to December 31 for the
upcoming calendar year.
A copy of this Verification Letter must be included with every bid exceeding $150,000
submitted to the City of South Bend Board of Public Works, along with your Pre -Qualified
Bidder Checklist and attachments.
If you have any further questions regarding this matter, please call this office at (574) 235-
9251.
Sincerely,
Liz Horvath, Permit Manager
POWER OF ATTORNEY APPOINTIiiG INDI MUAL ATTORNEY INTACT
Know All Men By Thew Prmat s, That Continental Casco dty Company, in Illi aois iuzcaaoae eompauy, National Fine famrance company of
Hartford, an Illinois insurance company, and American Casuahy Company ofReading, Penusybraia, a Pennsylvania insurance company (haek called
the CNA Companies"), are duly organized and existing insurance companies having theirprincipal offices in the City ofChixago, and State of UliuQis,
and that they do by virtue of the signatures and seals herein affixed hereby make, constitute aDd appoint
Angela M. Riley, Indh'idadly
of Indianapolis, IN their true and lauu<W Attoraey(s)-ia-Fact with fntl potter and authority hereby conferred to sign, seal and ate for and
an their behalf bonds, undertakings and other obligatory innsunments of similar nature
- In UnUmited Amounts -
3Xep►WWNA; Bid Bond
Rlocipak Milestone Contractors North, Inc.
City of South Bend
and to bind them tbovby as faulty and to the $aute antenna as if sucb instrumem were signed by a duly sudwrized ofeer of their inataEa= amgtanits and
all the acts of said Attorney, pursuant to the authority hereby given it bereby ratified and confirmed.
This Power of Attorney is made and executed pursuant to and by authority of the ByL m a and Resolutions, printed on the mtWW hereof; duly
adopted, as indicated, by the Boards of Directors of the iriwranct companies.
In Witness Whereof, the CNA Companies have caused these presents to be signed by their Vice President and their corporate seals to be hereto
affixed on this 9th day of May, 2023,
*%S"4!4Ix
W4SEALfast o
Cortdtteatal CaSWty Company
National Fire~ Itmrance Company of Hartford
Ame rkan Casaatty Company of Reading, Posy vania
GkI..' =�r7e--.
fatty I5ia Vice PPesidw
State of South. Dakota, County of Mmnehaba, sr.
Ott this 9th day of May, 2023, before we personally aurae Larry Kasten to ern known, who, bring by me duty sworn, did depose mid say. that he
resides in the City of Sioux Fads State of South Dakota; that he is a Vitt President of Continental Casualty Company, an Mia ois iusuran= company,
National Fire ins mace Companny of Hartford, an Illinois insuassuce company. and Awn Casualty Company of heading, Peansyhmuia, a
Pennsylvania imsur=m company described 'ear and which executed the above instruaesil,- that he knows the seals of said insurance companies; Burt the
seats affixed to the said instnuntzi: are su cit corporate seas; that they were so affixed puaauaat to authority tiivu by the Boards of Directors of said
insurance companies and that he signed his name thereto pw umw to hike authority, and acknowledges same to be the act and deed of said insurance
Companies.
1s1. BEFti
My Commission Exp m March 2, 2026 M. Bent Rotary Pretax
CERTIFICATE
1, D. Johnson, Assistant Secretary of Contineatal Casnatty Company. an UR nois insurance company, National Fire huurance Company of Hartford,
an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pe nsylvania insurance company do hereby Certify that the
Pourer of Attorney berein above set forth is stiff in force, and furdw cet* that the By -Laws and Resolutions of the Board of Directors of the karance
companies printed on the reverse hereof is still in force. In testimony whereof I have bereunto subscribed my name and affixed the seal of the said.
invxancc Coarpaaies this 23rd dayof May 2023.
t °� tp1� ^aaubtt,� m Contum=WCasualty Company
Nataoxtal Fee It ce Company of Hartford
e 3 taxvt o •a Ames afar Casualty Company of Reading. Pennsylvania
D. John= As 9ztt Semtaty
Foam Fogs 4=?82
Co to t�rw+�n �Pi lifiwt rr`y pbligee Services > validate Bond Coverage, If you want to verify bond authentidty.
Aut`orWna By -Laws and Rtsolatioas
This Power of A:torwy is sipwd by Lary Kasten, Vice President of coda of tea CNA Cowponies (as defiasd in the Pow= of AttmrA, who ius ben aathosined
pmmm ba the bedew Bylnm xmd Rasohrt = to eocwaw power of attorneys on bebalf of each of titre CNA Cvc*=in.
ADOPTED BY THE BOARD OF DIRECTORS OF CONTDMNTAL CASUALTY COMPANY
M Power of Aft my is aside and amcuted pursuant to mid by audwity of the following resohdim duly adopted by the Board of Directors of the Company ai a
mar . held an May 12,1995:
"RESOLVED: That amy Senior or Group Via Pmidesd may authorise as offiew to sip specific doe air ob, Wen ments and mstrurenrnts ou behalf of the Company
tine protiithere &d ssarae of RK U ardhtx>Aed oibees ward a dtsC:iytiwn of the dacsr:aeats, agrenroemb or that Such 9scMay sip will be provided in
"I ..ns by the Senior er Grow Vice President to the Secretaryof the Compny prior to soah eroecutiou becoming effacth-*7
This Power of A"oewy ii signed and sealed by hesi=k wader and by the tr tLority of to Wkwia; Resohf" adopted by the Board of Directors of tot Compnw by
aaaxumo wince e=sW daMd d* 2S* dry of April, 2012
"Whereas, the bylaws of the Compaw or specific resolution of Ilse Board of Directors has athorized %-aiom offiom (the" Authorised Offictts") i o omu w %=iom
poiides, bonds, s ad other obiipsovy inshunamb of like naturm and
Whetea, Avo time to fin*, the siputurn of fbe Aruborimed Officers, in addition to being pmvkd in odSkA hard copy Sormii, essay be prorided via facsimile or
etierwise m aea adecnwric fopo►at (cellectirely, "Ehctiaaic Sipoartezes"); IJow ehasefore be is revolt ed thee the Ekew=x Sipstme of auq Authorised Of SCer shall
be caSd amd binding on the Ccwpaay."
Ibis Power of Aboenry rosy be Aped by dual sputum and sealed by a digital at otherwise eleCirouicVfotmaSsed corporate seal under and by the atathorigr of the
following Iiawiation adopted by do Board of Directors of the Compaw by asarsm m written ¢assent dazed the 27th day of April, 2022:
"RESOLVED: That it is is the best kwrest of the Company to pesiodically rA* and cooum my corporate docvumft sued by dsgAd 4uhm and to ru*
and caafirm the use of a digital at otherwise ekctmonk-fomrdad corporate sane, each an, be oomidered the act and deed ofthe Compmy.7
ADOPTED BY THE BOARD OF DIRECTORS OF NATIONAL FIRE INSURANCE OOMPANY OF HARTFORD:
This Power of Attortrry is Wade and aacuted rursuid to aid by aWhotity of the Mowing rwoldim duly adopted by the Board of Directors of the Company by
®amorous writua tomast dated May 1.0, I99S:
`RESOLVED. That any Senicror Grout' Vice President may authorise an o$rmer to sire specific docamews, Venoms mid mstnaomts on behalf of tie conwauy
yioridtd tfut t}x rsaume of s uei atthoeisrd offiat and a desasptioa of lice deeummsts, agreemmzs or 6shatumft that sock officer nuy sirs will be provided iu
w ritis� by the Seniaror Gsoop Via lsresidert to the Seert� of the Coorpary priaa to such eroeeution beconniar effsetiiY.'
This Power of Attocsey is signed and sealed by iaesimde corder and by the sunny of the following Resolution adopted by the Board of DizKtion of dw Company by
ematsimoin vnium tomew dated the 25* day of April. 2012:
"Whereas, the bylaws of the Company or specific mokstm of tie Boardef Directors has a xalodsed v mxm offices (the "Aud a nzed Offloers") to execute %emus
poSoes, bowls. gs and otter obiigaeory imbm an of Wu nature; and
Whnsis, from time to tint, the sigpature of the Authorised Officers, is addition to being provided m odgual, hard copy format, may be pvwvsded via f csinule or
otheswiu is m ekettu k forme (collettivdy, "zdecb=k Ssputmes"ls Now the efote be it resohtid fist the Eket mole Signature of any Authorised Officer shall
be valid and binding on the Comport'."
This Poway of Aftomey may be signed by digital sipature and sealed by a digital or otherwise elechook-konatted corporate seal order and by the authority of the
followi:a g Resolution adopted by the Board of Directors of tie Cbupa W by urmsmoas wrriZtea consort dated the 27th day of Apni, 2022:
"RESOLVED: That it is in the best interest of the Compny to periodicaAy ratify and can8rtu any corporate documents signed by digital sSramm nd to ru*
ad conf nn the use ofa diriul or otherwise elackoniafi xua ted co pony seal, each to be considered the act and deed of** Company."
ADOPTER BY THE BOARD OF DIRECTORS OF AbfER1CAN CASUALTY COMPANY OF READING. PENNSYLVANM
Tbss Power of Aztoraey is made and a mooed puam mt to and by authority of tht ukwmg raohtsou duly adopted by the Board of Directors of the Compmy by
waamimouu written cooseat dazed May 10,1995:
RESOLVED: Thu any Smoror Grov Via President ray autborise an officer to sip specific docmnems, agrameuts and k*xmu=ft oa behalf of the C*upmy
provided that the same of soth aathmized oiirer and a dneriptioa of the docanmots, apwc mts or iashummts fiat sash officer may sips will be provided in
writing by the Senior or Group Vtte Preside= to tho Secretary of tht Company prior to such execution becoming efectim."
This Power of Atweney is signed and sealed by facsimile under and by the ardisority of the following Resolution adopted by the Board of Directors of the Company by
tmansmotn wmittm cement dated the 25* day of April, 2012:
"Whereas, the bylaws of the Coagsany or specific resohtsrn of the Board of Di eczots has sahoriud various officers (do "Authorized Ofircers7 m emcv" various
poheies. bonds, umdert*kp and other obligatory iwbumtnts, of blre ruzme; and
Wher*as, firm time to time, the signature of the Autbotixed Offwws, in addition to being pem ided in original, hard copy f mmaf. may be provided via facsimile or
otherwise m m electronic 6oraut (colleetivety. "Elecz<u Sipaahues"k Now therefore be st resoh-e& list the Electsonst SWutme of any Av6onz*d Officer shall
be valid and binding on the Company."
Tkis Power of AMomty may be sipod by digital sipatm wad sealed by a digital or otherwise dectruck-f mused ecepwim seal under and by toe authority of the
following Resolution adoptedby the Bomd of Directors of the Canpaay by umanimom written comml dazed the 27th day of April, 2022:
"RESOLVED: That it is in the best interest of the Cornpauy to pesiodicatly ratify and confirm any corporate dorusasems sinned by digital sip>atures and to ratify
and toofrm the use of 3 digital of otherwise electronic-foamatt;d corporate seal, each to be considered the act and deed of the Comopa:W "
CONTRACTOR'S BID FOR PUBLIC WORK - FORM 96
State Form 52414 (R2 / 2-13) / Form 96 (Revised 2013)
;.. Prescribed by State Board of Accounts
PART I
(To be completed for all bids. Please type or print)
Date (month, day, year): May 23rd, 2023
1 Governmental Unit (Owner): City of South Bend, Indiana
2. County: St. Joseph
3. Bidder (Firm): Milestone Contractors North, Inc.
Address: 24358 SR 23
City/State/ZlPcode: South Bend, IN 46614
4. Telephone Number: (574) 288-4811
5. 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 West Race Gate Repair - Project No. 122-063
(Governmental Unit) in accordance with plans and specifications prepared by Lawson -Fisher Associates P.C.
and dated April 19th, 2023 for the sum of
See Attached $ See Attached
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 governmental unit. If the bid is to be awarded on a unit
basis, the itemization of the units shall be shown on a separate attachment.
The contractor and his subcontractors, if any, shall not discriminate against or intimidate any employee,
or applicant for employment, to be employed in the performance of this contract, with respect to any matter
directly or indirectly related to employment because of race, religion, color, sex, national origin or ancestry.
Breach of this covenant may be regarded as a material breach of the contract.
CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS
(if applicable)
I, the undersigned bidder or agent as a contractor on a public works project, understand my statutory
obligation to use steel products made in the United States (I.C. 5-16-8-2). 1 hereby certify that I and all
subcontractors employed by me for this project will use U.S. steel products on this project if awarded.
understand that violations hereunder may result in forfeiture of contractual payments.
The above bid is accepted this
following conditions:
Contracting Authority Members:
ACCEPTANCE
_ day of I , subject to the
PART II
(For projects of $150,000 or more —1C 36-1-12-4)
Governmental Unit: City of South Bend, Indiana
Bidder (Firm) Milestone Contractors North, Inc.
Date (month, day, year): May 23rd, 2023
These statements to be submitted under oath by each bidder with and as a part of his bid.
Attach additional pages for each section as needed.
SECTION I EXPERIENCE QUESTIONNAIRE
1. What public works projects has your organization completed for the period of one (1) year prior to the
date of the current bid?
2.
Contract Amount Class of Work
Completion
Date
Name and Address of Owner
6,959,600.00
Resurface
November 2022
Lake County Hwy Dept
INDOT
5,589,894.00
Resurface
October2022
5,457,310.00
Resurface
November2022 Town of Merrillville
2,101,053.00 Resurface
October2022 Town of St. John
What public works projects are now in process of construction by your organization?
Expected
Contract Amount
Class of Work
Completion
Name and Address of Owner
Date
24,738,412.00
Sidewalk Removal/Replacement
September 2023
Town of Griffith
15, 394, 787.00
Concrete Pavement Restoration
May 2024
I N DOT
7,020,500.00
Resurface
October 2023
Lake County Hwy Dept
3.241.287.00
Resurface
October 2023
City of Crown Point
3.
Have you ever failed to complete any work awarded to you? No
If so, where and why?
4. List references from private firms for which you have performed work.
Gatlin Plumbing & Heating, Inc. 1111 E. Main St., Griffith, IN Ms. Patti Centrowski
Gough, Inc. 2200 E. 88th Dr., Merrillville, IN Mr. Raymond Gough
Dyer Construction Co., 1716 Sheffield Avenue, Dyer, IN Ms. Janet Furman
Grimmer Construction Co., Inc. 2619 Main St., Highland, IN Mr. Greg Grimmer
SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE
1. Explain 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 governmental unit to consider your bid.)
As required by owner
2. Please list 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.
See attached list
If you intend to sublet any portion of the work, state 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 governmental unit in the event that you subsequently determine that you will use a
subcontractor on the proposed project.
Will supply upon award of contract
4. What equipment do you have available to use for the proposed project? Any equipment to be used by
subcontractors may also be required to be listed by the governmental unit.
See attached list
5. Have you entered into contracts or received offers for all materials which substantiate the prices used in
preparing your proposal? If not, please explain the rationale used which would corroborate the prices
listed.
Yes, we received quotes from potential subcontractors and suppliers
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 governing body awarding the contract must be specific enough in detail so that said governing body can make
a proper determination of the bidder's capability for completing the project if awarded.
SECTION IV CONTRACTOR'S NON — COLLUSION AFFIDAVIT
The undersigned bidder or agent, being duly sworn on oath, says that he 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 include 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.
He 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.
SECTION V OATH AND AFFIRMATION
HEREBY AFFIRM UNDER THE PENALTIES FOR PERJURY THAT THE FACTS AND INFORMATION
CONTAINED IN THE FOREGOING BID FOR PUBLIC WORKS ARE TRUE AND CORRECT.
Dated at South Bend this
,,,v a`c tors����i
LORPORATe :
���rarla�cs�`
STATE OF Indiana
COUNTY OF St. Jose
Milestone
By
) ss
day of May 2023
rs orth, Inc.
Hilary, Director of Estimating
(Title of Person Signing)
ACKNOWLEDGEMENT
Before me, a Notary Public, personally appeared the above -named Dustin P. Hilary and
swore that the statements contained in the foregoing document are true and correct.
Subscribed and sworn to before me this 23rd day of May 2023
My Commission Expires: June 5, 2030
County of Residence: LaPorte
Notary Public
ALISHA KRUEGER
;otv PUB`:6.
My Commission Expires
°* SEAL*-.
June 5,2030
9T -?=
Commission Number NP0653544
OF
La La Porte County
Part of State Form 52414 (R2 / 2-13) / Form 96 (Revised 2013)
Milestone Contractors North, Inc.
(Contractor)
24358 SR 23
(Address)
South Bend, IN 46614
FOR
PUBLIC WORKS PROJECTS
Ng
City of South Bend, Indiana
West Race Gate Repair
Project No. 122-063
Filed May 23rd 2023
Action taken
The undersigned hereby declares that the foregoing is a true statement of the financial
or corporation herein first named, as of the date herein first given; that this statement is for the
whom it is submitted to award the submittor a contract; and that any depository, vendor or er
to supply such party with any information necessary to verify this statement.
NOTE: A co -partnership must give firm name and signatures of all
partners. A corporation must give full corporate name, signature of official
and affix corporate seal.
STATE OF
COUNTY OF
of the individual, co -partnership
pose of inducing the party to
jein named is hereby authorized
.i•- fir `p rtCditpt, JAI
Affidavit far ividual co •.......
•CARP0RA;F •••
{ss: _ is
' 3
being duly sworn, dep66jI.idS tAthl e.. - Z
foregoing financial statement, taken from his books, is a true and accurate statement of his financial condition as 6�the 8 to thereof,gnd
that the answers to the foregoing interrogatories are true.
Subscribed and sworn to before me this
_day of _ 20.
Notary Public
STATE OF
COUNTY OF
member of the firm of
I ss
(Applicant must sign here)
Affidavit for Co -Partnership
duly sworn, deposes and says that he is a
that he is familiar with the books of the said
firm showing its financial condition; that the foregoing financial statement, taken from the books of the said firm , is a true and accurate
statement of the financial condition of the said firm as of the date thereof and that the answers to the foregoing interrogatories are true.
(Member of firm must sign here)
Subscribed and sworn to before me this
_day of 21
Notary Public
Affidavit for Corporation
STATE OF Indiana
{ COUNTY OF St. Joseph ss
Dustin P. Hilary being duly sworn, deposes and says that he is Director of 7�sa
Mi ne Contractors North Inc. , the
corporation described in and which executed the foregoing statement; that hith t ooks of the � corporation showing its
financial condition; that the foregoing financial statement, taken from the bod c do a true and accurate statement of
the financial condition of said corporation as of the date thereof and that thee ng interrogatories are true.
( f er must sign here) Dustin P. Hilary, D � of fifl*k.g
��� ot�g..........rs
Subscribed and sworn to before me this
o ;' pRP 0 R A% •• ;�� ��.
23ra day of May. 2{123.
"
8L
`
•'
.,,'may'• SE
� •• •' i
,
Alisha Krueger, Notary Public
ALISHA KRUEGER
my Commission Expims
SEAL :* June 5, 2030
_; Commission Number NP0653544
"N6d.4" La Porte County
15
State of Indiana
Office of the Secretary of State
CERTIFICATE OF EXISTENCE
To Whom These Presents Come, Greeting:
I, DIEGO MORALES, Secretary of State of Indiana, do hereby certify that I am, by virtue of the laws of
the State of Indiana, the custodian of the corporate records and the proper official to execute this
certificate.
I further certify that records of this office disclose that
MILESTONE CONTRACTORS NORTH, INC.
duly filed the requisite documents to commence business activities under the laws of the State of
Indiana on March 29, 1966, and was in existence or authorized to transact business in the State of
Indiana on May 17, 2023.
I further certify this Domestic For -Profit Corporation has filed its most recent report required by
Indiana law with the Secretary of State, or is not yet required to file such report, and that no notice of
withdrawal, dissolution, or expiration has been filed or taken place. All fees, taxes, interest, and
penalties owed to Indiana by the domestic or foreign entity and collected by the Secretary of State
have been paid.
STerAi
In Witness Whereof, I have caused to be affixed my
signature and the seal of the State of Indiana, at the City
of Indianapolis, May 17, 2023
MOM 71AN
1% a Fd r mm,
DIEGO MORALES
SECRETARY OF STATE
194484-057 / 20233187486
All certificates should be validated here: https://bsd.sos.in.gov/ValidateCertificate
Expires on June 16, 2023.
State of Indiana
Office of the Secretary of State
Certificate of Amendment
of
WALSH & KELLY INC
I, CONNIE LAWSON, Secretary of State, hereby certify that Articles of Amendment of the above
Domestic For -Profit Corporation have been presented to me at my office, accompanied by the fees
prescribed by law and that the documentation presented conforms to law as prescribed by the
provisions of the Indiana Code.
The name following said transaction will be:
MILESTONE CONTRACTORS NORTH, INC.
NOW, THEREFORE, with this document I certify that said transaction will become effective Monday,
February 01, 2021.
In Witness Whereof, I have caused to be affixed my
signature and the seal of the State of Indiana, at the City
of Indianapolis, February 01, 2021
CONNIE LAWSON
SECRETARY OF STATE
J 94484-057 / 8878219
To ensure the certificate's validity, go to https://bsd.sos.in.gov/PubliceusinessSearch
State of Indiana
Office of the Secretary of State
Certificate of Assumed Business Name
of
MILESTONE CONTRACTORS NORTH, INC.
I, CONNIE LAWSON, Secretary of State, hereby certify that a Certificate of Assumed Business Name of the
above Domestic For -Profit Corporation has been presented to me at my office, accompanied by the fees
prescribed by law and that the documentation presented conforms to law as prescribed by the provisions
of the Indiana Code.
Following said transaction, the above named entity will transact business under the assumed business
name(s) of -
WALSH & KELLY
NOW, THEREFORE, with this document I certify that said transaction will become effective Monday,
February 01, 2021.
In Witness Whereof, I have caused to be affixed my
signature and the seal of the State of Indiana, at the City of
Indianapolis, February 01, 2021.
CONNIE LAWSON
SECRETARY OF S1A1 E
194484 057 / 8878234
To ensure the certificate's validity, go to https://bsd.sos.in.gov/PublicBusinessSearch
CERTIFICATE OF QUALIFICATION
to provide
CONSTRUCTION SERVICES
for
PUBLIC WORKS PROJECTS
to the
STATE OF INDIANA
This Certification Board, having duly considered application for qualification in terms of apparent experience and financial
resources; and under the applicable Indiana Code 4-13.6-4 and adopted rules of this Board, hereby issues a
Certificate of Qualification to provide construction services to the State of Indiana for Public Works Projects to:
MILESTONE CONTRACTORS NORTH INC
1700 E MAIN ST
GRIFFITH IN 46319
Phone 219-924-5900
Fax 219-924-8768
Company Official
TODD FAWVER
for the twenty-seven month period stated herein, unless revoked by this Board for cause,
and in the classifications of services stated below. This certificate supercedes any previous certificate.
1611.01 Concrete Construction of Roads & Curbing
1611.02 Asphalt Construction of Roads and Parking Lots
CERTIFICATION DATE 2/1/2023
EXPIRATION DATE 5/1/2025
THIS CERTIFICATE ISSUED BY THE STATE OF INDIANA, PUBLIC WORKS DIVISION CERTIFICATION BOARD,
402 WEST WASHINGTON STREET, ROOM W467, INDIANAPOLIS, INDIANA 46204,
ALSO ACTS AS THE OFFICIAL NOTICE OF EXPIRATION.
K-ti � • ��
Tracy L. Cross, ExPutive Secretary
Certification Board
DAPW PQ2 State Forth 39B3R Rev. 07106
WRITTEN CONSENT TO RESOLUTIONS
of the
BOARD OF DIRECTORS
of
MILESTONE CONTRACTORS NORTH, INC.
The undersigned, being all of the Directors of MILESTONE CONTRACTORS NORTH, INC., an
Indiana Corporation, hereby consent to the following actions to be taken by the Corporation without a
meeting of the Board of Directors under the applicable provisions of the Indiana Business Corporation Law,
as amended:
RESOLVED that the following be, and hereby are, elected officers of the Corporation, to
hold the office until the next regular meeting of the Board of Directors and until their
successors are duly elected and have qualified:
Todd A. Fawver President
Charles Potts Jr.
Chief Operating Officer, Construction
John P. Vercruysse
Executive Vice President
Mark Andrews
Executive Vice President
David L. Franz
Vice President
John M. Peisker
Vice President, Production
Patrick J. Walters
Vice President, Finance
Brad McCall
Vice President, Estimating
Derek Merida
Vice President, Bridge Operations
David M. Kozyra
Vice President/Area Manager Griffith
Lynn J. Bauer
Vice President/Area Manager South Bend
Danielle Payne
Assistant Controller, Secretary and Treasurer
RESOLVED FURTHER that the above officers be, and they hereby are, authorized to
execute all contracts or similar documents on behalf of the Corporation. In addition to
the above officers the following are hereby appointed as authorized signers on behalf
of the Corporation:
David J. Misirly Senior Estimator
Gregory A. Hoffman Director of Estimating, Griffith
Dustin P. Hilary Director of Estimating, South Bend
Mark E. Krachenfels Construction Manager
RESOLVED FURTHER that the actions of the Officers of the Corporation taken since
the last meeting of the Board of Directors be, and the same hereby are, fully ratified
and approved.
RESOLVED FURTHER that this consent shall be in lieu of an annual meeting of the Board
of Directors of the Corporation and shall be filed in the minute book of the Corporation in
place of any such annual minutes.
<<SIGNATURES ON THE NEXT PAGE>>
EXECUTED this 26th day of August, 2021.
A, .7�� 1 � -
Fred Fehsenfeld,Jr.
Geoffrey C. Dillon
James ehsenfeld
P.
J P. Vercruysse
P,i; Milestone
DATE: May 24, 2022
TO: All Employees
RE: EEO Officer Appointment
Margaret Garner has been appointed Equal Employment Opportunity Officer for Milestone
Contractors. It is her responsibility to coordinate, advise and assist management and
supervisors in their responsibilities of assuring all applicants and employees' equal
opportunities in all aspects of their employment. She will review complaints that allege
discrimination because of race, religion, color, sex, sexual orientation, gender identity, age,
national origin, disability, housing status or veteran status.
Employees of Milestone Contractors are to submit any issues or concerns to Margaret. We are
committed to comply with the provisions of the Civil Rights Act of 1964 and 1991, plus all
Executive Orders issued relating to Equal Employment.
Margaret's contact information is listed below.
Milestone Contractors
5757 Decatur Blvd, Suite 250
Indianapolis, IN 46241
(317) 616-4937
LZ4�-? -
CJ Potts, Chief Operating Officer
0.4
�milestone
EQUAL EMPLOYMENT OPPORTUNITY/
AFFIRMATIVE ACTION POLICY STATEMENT
It is the policy of Milestone Contractors to afford equal opportunity for employment to all individuals regardless of
race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, housing status, or
veterans' status. The corporation is committed to this policy by our status as a federally assisted government
contractor. We are far more strongly bound to the policy by the fact that adherence to the principles involved is the
only acceptable American way of life. Therefore, it is the policy of this corporation to assure that applicants are
employed, and that employees are treated during employment without regard to race, color, religion, sex, sexual
orientation, gender identity, national origin, age, disability, housing status, or veterans' status. Such action shall
include: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or
termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship, pre -
apprenticeship, and/or on-the-job training.
The successful achievement of a nondiscriminatory employment program requires a maximum of cooperation
between management and employees. In fulfilling its' part in this cooperative effort, management is obliged to lead
the way by establishing and implementing affirmative procedures and practices which will ensure our objective,
namely equitable employment opportunity for all. (Minority and female employees are encouraged to participate
in all company activities and refer applicants.)
I have designated Margaret Garner to direct the establishment of and to monitor the implementation of personnel
procedures to guide our affirmative action program. This official is charged with designing and implementing audit
and reporting systems that will keep management informed on a regular basis of the status of equal employment
opportunity and affirmative action. She can be reached at (317)616-4937.
Supervision has been made to understand that their work performance is being evaluated based on their equal
employment opportunity efforts and results, as well as other criteria. It shall be a responsibility of the supervision
to take actions to prevent harassment of employees placed through affirmative action efforts.
We shall comply with the Civic Rights Act of 1964, as amended, the Federal Highway Act of 1968, the Executive Order
#11246 and #11375, the Rehabilitation Act of 1973, as amended, the Vietnam Era Veterans Readjustment Assistance
Act of 1974, as amended, the Indiana Civil Rights Act and other applicable Federal and State Laws and regulations
pertaining to equality of Opportunities and Affirmative Action policies. We have developed an Affirmative Action
Program for Veterans and Individuals with Disabilities.
CJ Potts, Chief Operating Officer
Margaret Garner, HR Area Partner/EEO Officer
January 2023
emirs lar QuawUmItan
boo Bra Of &Iwts
INDIANAPOLIS, IN October20, 2022
TO
MILESTONE CONTRACTORS NORTH, INC.
GRIFFITH, IN
vvho has filed with the Department a Contractof s Statement of Experience and Financial Condition as
required under Indiana Code &23-10, is hereby qualified to bid at any Department of Transportation
iefting in Classes of Work and within the amount anti other limitation of each classification as listed
below, for such period as the uncompleted work on hand from al l sources does riot exceed the Aggregate
amount Classification references by name or symbol are in accordance with the definitions in the
Contractor's Statement of Experience and Financial Condition. This certificate supersedes any certificate
previously issued, but is subject to revision or revocation according to the law, I and when changes
in the financial condition of the contracting firm or other facts justify such revision or revocation.
Valid October 20, 2022 Thru September 30, 2023
Aggregate Bidding Capacity: 327,748,000.00
A(B) CONCRETE PAVEMENT: LIMITED................................................................................... $25,000,000.00
B(A) ASPHALT PAVEMENT: W/INDOT CERTIFIED HMA PLANT ............................................. $99,999,999.00
C(B) LIGHT GRADING............................................................................................................... $99,999,999.00
E(E) SMALL STRUCTURES AND DRAINAGE ITEMS.............................................................. $25,000,000.00
E(F) SURFACE MASONRYAND MISCELLANEOUS CONCRETE ........................................... $50,000,000.00
E(G) TRAFFIC CONTROL: PAVEMENT MARKINGS................................................................ $25,000,000.00
E(H) DEEP SEWER AND/OR EXCAVATION.............................................................................. $25,000,000.00
E(Q) CONCRETE PAVEMENT: REPAIRS.................................................................................. $25,000,000.00
E(R ) ASPHALT PAVEMENT MILLING....................................................................................... $50,000,000.00
PREQUALIFICATIOM ENGINEER
ft* lams 205M (R3 / 605)
I �fs'44�&
COMLSSSK)NER
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date 05/10/2023
Name Zach Hurst Department DPW
BPW Date 05/23/2023 Phone Extension 3057
Review and Approval Required Prior to Submittal to Board
Diversity Compliance ❑
Officer Name
and Inclusion Officer
BPW Attorney
❑ Attorney Name
Dept. Attorney ❑ Attorney Name
Purchasing ❑
Check the Appropriate Item Type — Required. for All Submissions
❑ Professional Services Agreement ❑ Contract ❑ Proposal
❑ Open Market Contract ❑ Amendment/Addendum ❑ Special Purchase, QPA
® Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet
❑ Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes
❑ Proposal Opening ❑ C/O & PCA No. ❑ PCA
❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution
n Other: n Ease./Encroach
Company or Vendor Name
New Vendor
MBE/WBE Contractor
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description
Information
U Yes U If Yes, Approved by Purchasing
❑ No
❑❑ ❑
MBE Completed E-Verify Form Attached ❑ Yes
No
West Gate Repair
122-063
Storm Sewer Fund
PR-00024383
Request to open bids for replacement of West Gate at Century Center
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: