HomeMy WebLinkAboutOpening of Bids - Cleveland Rd. & Ameritech Dr. Imprvmnts. Proj No. 122-049 - Premium ConcreteCITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
Project Name Cleveland Road and Ameritech Drive Intersection Improvements
Project No.
For Bids Due
Date:
Address:
City/State/Zip:
August 22, 2023
(Must be
completed for all bids.
Please type or
print)
8/22/23
Bidder (Firm):
PREMIUM
CONCRETE SERVICES
712 RICHMOND ST
ELKHART, IN 46516 Telephone Number: ( 574 ) 264-0196
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:
CLEVELAND ROAD & AMERITECH DR INTERSECTION IMPROVEMENTS
the City so t" Bend, Indiana, in accordance with plans and specifications prepared by:
A&Z ENGINEERING, LLC
anA dated
JULY 2023
for the sum of (enter the Total Bid as shown
on the Proposal)
ONE MILLION FIVE
HUNDRED SEVENTEEN THOUSAND THREE HUNDRED TWENTY-ONE DOLLARS ($
1,517,321.00 )
(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 submits a proposal for each in accordance
with the notice. Any addendums attached will be specifically referenced at the applicable page.
If additional units of material included in the contract are needed, the cost of units must be the same as that
shown in the original contract if accepted by the City of South Bend. If the b� be awarded on a unit
basis, the itemization of the units shall be By shown on a separate attach lSn
/'1 4X V�(Si gnature)
ririnted Na l (Pe of Person Signing)
ACCEPTANCE
The above bid is accepted this
Subject to the following conditions:
BOARD OF PUBLIC WORKS
Elizabeth A. Maradik, President
Gary A. Gilot, Member
Murray L. Miller, Member
Joseph R. Molnar, Member
Jordan V. Gathers, Member
Attest: Theresa Heffner. Clerk
Version 09/29/2021 Contractor's Bid for Public Works - 2
PART
II
or
projects
of $100,000 or more —
IC 36-1-12-4)
These statements to be submitted under oath
by
each
bidder
with and as part of his/her/its bid.
Attach additional pages
for
each
section
as needed.
SECTION I EXPERIENCE QUESTIONNAIRE
1. Attach information regarding projects your organization has completed for the period of one
(1) year prior to the date of the current bid.
2. Attach a listing of public works projects currently in process of construction by your
organization.
3. Attach information regarding any failure to complete any work awarded to you and the
location thereof.
4. Attach references from private firms for which you have performed work.
SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE
1. Attach an explanation of your plan or layout for performing proposed work. (Examples could
include a narrative of when you could begin work, complete the project, number of workers,
etc. and any other information which you believe would enable the City of South Bend to
consider your bid.)
2. Attach a listing of the names and addresses of all subcontractors (i.e. persons or firms outside
your own firm who have performed part of the work) that you have used on public works
projects during the past five (5) years along with a brief description of the work done by each
subcontractor.
3. If you intend to sublet any portion of the work, attach the name and address of each
subcontractor, equipment to be used by the subcontractor, and whether you will require a
bond. However, if you are unable to currently provide a listing, please understand a listing
must be provided prior to contract approval. Until the completion of the proposed project, you
are under a continuing obligation to immediately notify the City of South Bend in the event that
you subsequently determine that you will use a subcontractor on the proposed project.
4. Attach a listing of equipment you have available to use for the proposed project.
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 Contractors Bid for Public Works - 3
Premium Concrete Services, Inc.
712 Richmond Street
Elkhart, IN 46516
(574)264-0196
SECTION I EXPERIENCE QUESTIONAIRE
1) PUBLIC WORKS PROJECTS COMPLETED IN PAST YEAR:
CONTRACT
AMOUNT
COMPLETION
DATE
OWNER
$
387,923.00
CURB & SIDEWALK
11/2022
CITY
OF
SOUTH BEND
$
217,860,00
CONCRETE PROJECTS
12/2022
CITY
OF
ELKHART
$
481,500.00
CURB RAMPS & SIDEWALK
5/2023
CITY
OF
ELKHART
$
570,000,00
STREETSCAPE
6/2023
CITY
OF
ELKHART
$
568,005,00
CURB & SIDEWALK
6/2023
CITY
OF
SOUTH BEND
2) PUBLIC WORKS PROJECTS IN PROGRESS:
CONTRACT
AMOUNT
COMPLETIO
N DATE
OWNER
$ 250,000.00
CURB & SIDEWALK
10/2023
CITY OF MISHAWAKA
3) HAVE NEVER FAILED TO COMPLETE ANY WORI<THAT WAS AWARDED TO US.
4) REFERENCES:
a. NISOURCE-MR.LUI<EBRADLEY-1039PENNSYLVANIAAVESOUTHBEND,IN46601
b. COZIER MANUFACTURING - MR. I<EN MURR -402 N MAIN MIDDLEBURY, IN 46540
0
Premium Concrete Services, Inc.
712 Richmond Street
El(hart, IN 46516
(574) 264-0196
SECTION II PLAN AND EQUIPMENT QUESTIONAIRE
1) Project: CLEVELAND RD & AMERITECH DR INTERSECTION IMPROVEMENTS # 122-049 -Schedule:
After given the notice to proceed, Premium Concrete Services, Inc. will review, establish right-of-
way, set up traffic control and layout area. We will then contact Indiana 811 to locate all utility
lines within construction limits. Next will be inlet protection, erosion control, removals,
excavation, pipe work and grading with a 3-4 man crew. Then layout with 2-man crew. Forming
and pouring of concrete work will be next with a 5-8 man crew. Subs will be utilized on this
project to complete traffic control, traffic signal work, striping & trucking . Multiple crews may be
working at the same time. Process will continue until all work is complete. Project with be
completed on schedule.
2) a) State Barricading Inc.- 24963 US 20 West South Bend, IN 46628—Traffic Maintenance &Signs
b) Acorn Landscaping— 3680 W Sample St South Bend, IN 46619—Top Soil and Sodding.
c) Kennedy Expressline —4324 Ashard Dr South Bend, IN 46628 - Trucking
d) Hawk Enterprises —1850 East North St Crown Point, IN 46307 - Electric
e) KC Tree, Inc —8913 East US Hwy 20 New Carlisle, IN 46552 —Tree Removal
f) A-1 Striping Service Inc. — 56825 Spirea Rd. New Carlisle, IN 46552 — Painting
g) Slusser's Green Thumb, Inc. —1610 Genesis Dr LaPorte, IN 46350 - Landscaping
h) Traffic Control Specialists —1810 W Pacific Ave Knox, IN 46534 — Traffic Maintenance & Signs
Premium Concrete Services, Inc. Does not require bonding for its subcontractors
3) Will supply list of subcontractors soon after award of project.
4) Equipment use for project: SI<id Steers, Mini Excavators, Excavators, Compactors, Rollers, Wallc-
behind Saws, Cut-off Saws, Friction Screed, Dump Trucl<. Current plan is to used owned
equipment, however depending on workload some rental equipment may be necessary.
S) Yes, Premium Concrete Services, Inc. has quotes for all materials in proposal.
When t/reprospective Contractor is tumble to certify to any of the statements below, tt slta!( attack an eep( nation to this Af,JPdavit.
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 _NDJO" )
) SS:
�U(f{AiCT COUNTY )
The undersigned Contractor, being duly sworn upon his/hedits oath, affirms under the penalties of perjury
that:
1. Contractor has not, nor has any other member, representative, or agent of the firm, company,
corporation or partnership represented by him, entered into any combination, collusion or agreement with
any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding
or to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and
without any agreement, understanding or combination with any other person in reference to such bidding.
Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or
indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and
2. 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 S om
participation in this transaction by any Federal department or agency; and
3. Conhactor has
not, nor
has any successor to, nor an affiliate of,
Conhactor,
engaged in
investment activities in
h•an.
a. For purposes of this Certification, "Iran" means the government PT and any agency
or instrumentality of h•an, or as otherwise defined at Ind. Code § 5-22-]6.5-5, as
amended from time -to -time.
b. As provided by hid. 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 ($2QOOQ,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 hidiana 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 Contractors
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 nuclei- this public contract to
certify that tine 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 subcontactor has enrolled in and is pailicipating in the E-Verify Program. The Contactor agrees
to maintain this certification throughout the term of the contact 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.
C>. Persons, firms, partnerships, corporations, associations, orjoint venturers awarded a contract by the
City of South Bend through its agencies, boards, or commissions shall not discriminate against any employee
r 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
r 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.
Contractor 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 subcontractor. 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 subcontractor employed by me for this project will use steel products or foundry
products made in the United States on this project if awarded. I Understand I have an affirmative duty to
notify the City in my bid that nny 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 ajustification
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 Slates, 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.
sa+
I hereby affirm under the penalties of petj ury that the facts and information contained in the foregoing bid
for public works are true and correct.
Dated this na day of Aj -, 2013
f�inwm &AUC TG SC Ry
Contractor/Bidder (Firm
Signature of C itractor/Bidder or Its Agent
P*xyCAKUN 4,rP.
Printed Name and Title
n�
Subscribed and sworn to before me this -�L day of U Cl . , 20
My Commission Expires A(�-
Not y Public
County of Residence r71KtlAKT
JANEEMTOWNER i
NOTARY PUBLIC
SEAL
ELWART COUNTY, STATE OF INDIANA
COMMISSION EXPIRES FEBRUARY 12.202a
COMMISSION NO.710399
Version 09/29/2021 Contractor's Bid for Public Works - 6
Project Name: Cleveland Road and Ameritech Drive Intersection Improvements
Project Number: 122-049
For Bids Due: August 8, 2023
ITEM
NO,
ITEM DESCRIPTION
QUANTITY
UNIT
UNIT
PRICE
TOTAL
AMOUNT
1
Construction Engineering
1
LS
17,500,00
17,500.00
2
Mobilization and Demobilization
1
LS
60,000
605000.00
3
Clearing Right of Way
1
LS
13,000.00
13,000.00
4
Excavation, Common
2462
CYS
45.00
110,790.00
5
Linear Grading
340
LFT
20.00
6,800.00
6
"B" Borrow
2100
CYS
48.00
1001800.00
7
Subgrade Treatment, Type II
2452
SYS 112.00
29,424.00
8
Compacted Aggregate, No. 53
817
TON 195.00
77,615.00
9
HMA Surface, PG70-22P, 9.5 mm, Type
C
63
TON
365.00
22,995.00
10
HMA Intermediate, PG64-22, 12.5 mm,
Type C
105
TON
255,00
26775.00
11
HMA Base, PG64-22, 25.Omm, Type C
336
TON
180.00
60,480.00
12
Joint Adhesive, Surface
216
LFT
5.00
1,080.00
13
Joint Adhesive, Intermediate
216
LFT
5.00
11080.00
14
Liquid Asphalt Sealant
216
LFT
5.00
11080.00
15
Asphalt for Tack Coat
1526
SYS
5.00
7,630.00
16
PCCP, 11.5"
1305
SYS
180.00
234,900.00
17
PCCP, For Patching
384
SYS
200.00
76,800.00
18
D-1 Contraction Joint
891
LFT
28.00
24,948.00
19
Type A Expansion Joint W/Dowels
168
LFT
50.00
8,400.00
20
Type E Longitudinal Construction Joints
672
LFT
20.00
13,440.00
21
Center Curb, Concrete
3
SYS
15500.00
45500.00
22
Curb, Integral, Concrete, 6 in.
56
LFT
100.00
51600,00
23
Curb, Concrete
130
LFT
65.00
81450.00
24
Sodding, Nursery
509
SYS
40,00
20,360,00
25
Topsoil
3
CYS
500.00
11500.00
26
Pipe, Type 2, Circular, 12 in.
2
LFT
750.00
11500.00
27
Pipe, Type 2, Circular w/Slotted Vane
Drain, 12 in.
40
LFT
750,00
30,000.00
28
Pipe, Type 1, Field Verified
20
LFT
38.00
760.00
29
Pipe, End Section, Field Verified
2
EA
500.00
1,000.00
30
Casting, Inlet, Adjust to Grade
2
EA
11500.00
31000.00
31
Casting, Manhole, Adjust to Grade
1
EA
25500.00
21500.00
32
Line, Multi -Component, Broken, White, 4
in.
683
LFT
2.00
11366.00
33
Line, Multi -Component, Solid, White, 4 in.
1999
LFT
2.00
31998.00
34
Line, Multi -Component, Solid, Yellow, 4
in.
1368
LFT
2.00
2,736.00
35
Line, Multi -Component, Solid, White, 10
in.
2060
LFT
3.00
6,180.00
36
Grooving for Pavement Markings
6110
LFT
2.00
12,220.00
Version 09/29/2021 Contractor's Bid for Public Works - 7
Project Name: Cleveland Road and Ameritech Drive Intersection Improvements
Project Number: 122-049
Fir PidQ nzip Atimigf R vnvn
37
BID
Transverse Marking, Multi -Component,
145
LFT
Crosshatch Line, White, 12 in.
10.00
1,450.00
38
Transverse Marking, Multi -Component,
207
LFT
25.00
5,175.00
StopLine, White, 24 in.
39
Pavement Message Marking, Multi-
3
EA
1,050.00
Component, Lane Indication Arrow
350.00
40
Signal Head, 3-Section, 12", Red, Amber,
6
EA
Green, Amber Arrow, Green Arrow
2,200.00
13,200.00
41
Signal Head, 5-Section, 12", Red, Amber,
4
EA
Green
3,200.00
12,800.00
42
Signal Cable, 5C/14
363
LFT
8.00
2,904.00
43
Signal Cable, 7C/14
242
LFT
9.00
2,178.00
44
Signal Cable, 9C/14
286
LFT
11.00
3,146.00
45
Existing Signal Equipment, Remove
1
EA
2,500.10
2,500.00
46
Temporary Pavement Marking,
in.
15731
LFT
3.00
47,193.00
Removable, 4
47
Temporary Pavement Marking,
181
LFT
18.00
3,258.00
Removable, 24 in.
48
Temporary Pavement Marking,
16
EA
250,00
4,000.00
Removable, Lane Indication Arrow
49
Line, Remove
1785
LFT
2.00
3,570.00
50
Sign, Remove and Relocate
4
EA
650.00
2,600.00
51
Concrete Pavement Remove
1305
SYS
50.00
1 65,250.00
52
Center Curb, Concrete, Remove
78
SYS
210,00
16,380.00
53
Curb Remove
70
LFT
28.00
1,960.00
54
Maintenance of Traffic
1
LS
320,000.00,
3201000,00
55
Erosion Control
1
LS
7,500.00
7,500.00
Bidder (Firm):
Premium Concrete Services Inc.
Address: 712 Richmond Street
City/State/Zip: Elkhart/IN/46516
TOTAL $1, 517, 321.00
Telephone Number: (574) 264-0196
(Signature)
Austin T. Redding
(Printed Name of Person Signing)
Version 09/29/2021 Contractor's Bid for Public Works - 8
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-1.0
MBE UTILIZATION PLAN
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MBE
participation. It is the bidder's sole responsibility to verify whether any listed minority -owned business meets the MBE qualifications.
Project Number: 122-049 Project Name: Cleveland Road and Ameritech Drive Intersection Improvements
c<-
Bidder: Premium Concrete Services Inc. Total Bid Amount: p / S/ 7 MBE Goal: 3.53
Page 1 of 1
Name &Address of MBE
Primary Contact Person
(Name(relephone)
Scope of Work to be Performed
(Attach scope/schedule if you need additional space)
Dollar Amount of MBE
Component
Percentage
of Total
Bid/Proposal
Kennedy Expressline
4324 Ashard Dr.
South Bend, IN
Marcus Northern
574-876-8881
Trucking/Material Hauling Services
3 `j(v�p
Submitted by: Austin Redding 8/8/23
Print Name Sign ure Date
Version 09l29/2021 Contractor's Bid for Public Works - 9
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.0
EVIDENCE OF GOOD FAITH EFFORTS
tt Ttlp �..
CS6N.=
This completed on. 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: 122-049 Project Name: Cleveland Road and Ameritech Drive Intersection Improvements
x>
Bidder: Premium Concrete Services Inc. Total Bid Amount: S/ 7 32/� WBE Goal: 5.64%
PagePageL. 1 of 1
Name &Address of WBE
Primary Contact Person
Scope of Work to be re, ormed
Dollar Amount of WBE
Percentage
of Total
(Name/Telephone)
(Attach scope/schedule if you need additional space)
Component
Bid/Proposal
State Barricading
James Michalski
Maintenance Traffic, Temp Striping
h CIO
�() OCo
4.
24963 US 20 West
(574) 287-2078
of
3 .
South Bend, IN 46628
Hawk Enterprises Inc.
Caylee Carlson
(269) 662-8093
Traffic Signaling
10
g
1850 E. North St.
Crown Point, IN
Submitted by:
Austin Redding
Print Name
818/23
Signature Date
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
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:
Date: i3�8�23
Project Name:
Cleveland
Road and
Ameritech
Drive Intersection Improvements
Bidder:
Premium
Concrete
Services
Inc. _
Contact Person:
Address:
City:
Email:
Austin Redding
712 Richmond Street
Elkhart State: IN
austin@premiumservices.group
Telephone: 574-264-0196
Zip: 46516
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: httr)://www.in.qov/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
X
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
p
performed by MWBEs, including, where appropriate, breaking out contract work items into
X �tl
tf
economically feasible units to facilitate MBE participation.
I affirm that I have made good faith efforts to solicit through all reasonable and available
X pQ
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
p
X RQ
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
X N
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
X 1111
sufficient time for MBEs to participate effectively.
I affirm that I followed up on initial solicitations with interested MBEs.
X 11�
I affirm that I negotiated with interested MBEs in good faith, including providing such MBEs
1(�?
with adequate information about the plans, specifications and other requirements of the
X R
subcontract.
n p
I affirm that I have made good faith efforts to assist interested MBEs in obtaining bonding,
X IMP
lines of credit, or insurance as required by the City or the bidder, where appropriate.
Version 09/29l2021 Contractor's Bid for Public Works -11
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.0
EVIDENCE OF GOOD FAITH EFFORTS
Xp
F
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.
X
[V�
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 Contractors Bid for Public Works - 12
om.
CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLANFORM 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 an Public
Works Projects
requiring Good
Faith Efforts
to obtain MWBE
participation.
Project Number:
Date: 818123
Project Name:
Cleveland
Road and
Ameritech
Drive Intersection Improvements
Bidder:
Premium
Concrete
Services
Inc.
Contact Person: Austin Redd
Address:
city:
712 Richmond Street
Elkhart
state: Indiana
Telephone: 574 264-0 I Ou
Z;p: 46516
Email: austin@premiumservices.group
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: httID://www.iin.qov/idoa/.
GOOD FAITH EFFORTS TO OBTAIN WBE PARTICIPATION
The bidder shall initial each item below, as evidence of its good faith efforts to obtain WBE participation
in the awarded contract.
I affirm that I reviewed the City of South Bend's Minority and Women Business Enterprise
X a
�4
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
X
economically feasible units to facilitate WBE participation.
I affirm that I have made good faith efforts to solicit through all reasonable and available
X K�
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
X
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
X
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
X
sufficient time for WBEs to participate effectively.
X
I affirm that I followed up on initial solicitations with interested WBEs.
VtQ
I affirm that I negotiated with interested WBEs in good faith, including providing such WBEs
(p
with adequate information about the plans, specifications and other requirements of the
X 1tF
subcontract.
I affirm that I have made good faith efforts to assist interested WBEs in obtaining bonding,
X
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 -13
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM WBE-2.0
EVIDENCE OF GOOD FAITH EFFORTS
irW
Dut
I affirm that I have made good faith efforts to assist interested WBEs in obtaining
X (yp
necessary equipment, supplies, materials, or related assistances or services, where
appropriate.
I affirm that I did not reject any WBEs as unqualified without sound business reasons
based on a thorough investigation of their capabilities.
CONTRACT RECORDS: The bidder has maintained the following records for each WBE that has bid on
the subcontracting opportunity:
1. Name, address, and telephone number;
2. A description of information provided by the bidder or subcontractor; and
3. A statement of whether an agreement was reached, and if not, why not, including any reasons for
concluding that the MWBE was unqualified to perform the job.
*Proper demonstration of Good Faith Efforts requires your initials next to all of the above boxes. Any
omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of
South Bend reserves the right to request additional information.
Version 09/29/2021 Contractor's Bid for Public Works - 14
Q'.
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:
MBE Participation Goal 3.53%
Project Name:
Cleveland
Road and
Ameritech
Drive Intersection Improvements
Bidder:
Premium
Concrete
Services
Inc.
By:
Estimator/PM
MBE Firm Kennedy Expressline
Owner or Contact at MBE Firm Marcus Northern
Telephone: (574) 876-8881 Fax: (574) 272-2302 Email: ken nedyexpressline(a�Vahoo.com
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Construction Trucking of matierials
RESULTS OF CONTACT WITH THE MBE FIRM:
Firm has given pricing and availabilty if awarded
MBE Firm
Owner or Contact at MBE Firm
Telephone: Fax: Email:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OF CONTACT WITH THE MBE FIRM:
Version 09/29/2021 Contractor's Bid for Public Works - 15
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
BE CONTACTED
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects
requiring Good Faith Efforts to contact WBEs. It is the bidder's sole responsibility to verify whether any listed
woman -owned business meets the WBE qualifications. Attach additional pages if necessary.
PAGE OF 1
Project Number: 122-049
Project Name:
Bidder:
By: , zQ z
WBE Participation Goal
5.64%
Cleveland
Road and
Ameritech
Drive Intersection Improvements
Premium
Concrete
Services
Inc.
(Title)
WBE Firm State Barricading
Owner or Contact at WBE Firm James Michalski
Telephone: (574) 287-2078 Fax: (574) 287-1744 Email: statebarricadel@aol.com
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Maintenance of Traffic and Temp Striping
RESULTS OF CONTACT WITH THE WBE FIRM:
Quote received and will use if awarded
WBE Firm Hawk Enterprises Inc.
Owner or Contact at WBE Firm Caylee Carlson
Telephone: (219) 662-8090 Fax: Email: Caylee@hawk-inc.com
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Traffic Signaling
RESULTS OF CONTACT WITH THE WBE FIRM:
Qoute received and will use if award
Version 09/29/2021 Contractor's Bid for Public Works - 16
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
CHECKLIST FOR BIDDERS
Project Name Cleveland Road and Ameritech Drive Intersection Improvements
Project No. 122=049
For Bids Due August 22, 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.
x 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
1� executed.
Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments
x 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
v Faith Efforts Forms [MBE-2.0 and WBE-2.0] and M/WBE Contacted Forms [MBE-2.1 and
WBE-2.1 ].
Acknowledge Receipt of 3 Addendum(s) included with the bid.
All required additional information is included with the bid.
X 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
documentation; however, it does not include all specifications requirements
relieve the bidder of the need to read and comply with the specifications.
Bidder: (REr't2K n CoNCRETC 5FRVZ .E5 Date: 8/-ZZ/�
By Authorized Representative:
Signature:
Print Name &Title: /�%A-X {%A -KEY ��/ rN.VE�
with required
and does not
Version 09/29/2021 Contractor's Bid for Public Works -1
-�- ��)cc��uli�ift10��� c, �p �0
IA] 0 • •J
CONTRACTOR: SURETY:
(Name, legal status and address) (Name, legal status and principal place
Premium Concrete Services, Inc. of business)
Old Republic Insurance Company
712 Richmond St P. O. Box 0941
Elkhart, IN 46516 Brookfield, WI 53008-0941
OWNER:
(Name, legal status and address)
City of South Bend Board of Public Works
County -City Building Room 1316, 227 West Jefferson Blvd
South Bend, IN 46601
BOND AMOUNT:
Five Percent of the Total Bid 5 % of Total Bid
PROJECT:
(Name, location or address, and Project number, if any)
Cleveland Rd and Ameritech Dr Intersection Improvements, Project No. 122-049
This document has important legal
conSequences,
an attorney is encouraged with
respect to its completion or
modification.
Any singular reference to
Contractor, Surely, Owner or
other party shall be considered
plural where applicable.
The Contractor and Surety ue bound to the Owner un 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 tune 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 fill 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 tine term Owner shall be deemed to be Coutractor.
When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the Project,
any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and
provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein. When so
furnished, the intent is that this Bond shall be construed as a statutory bond and not as a common law bond.
Signed and scale this 3rd day of August 2023
t Premium Concrete
1 (Princi nl (Seat)
Riess) Vila-Pveti7lnn�
(Title)JF
su
Old Republic Insurance Companv ` c
A.s'YJd�feo�l�2�"' Sure
E
(Witness)
(Title) e6ifer L. Kifimia, orney-in-Fact
CAUTION: You should sign an original AIA Contract Document, on w h this text appears in RED. An original assures that
changes will not be obscured.
Init, AIA Document A3101O —2010. Copyright 01963, 1970 and 2010 by The American Institute of Architects, All rights reserved. WARNING: This AIA°
Document Is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this Al a Document, or
any portion of it, may result In severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law.
/ Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail
The American Institute or Architects' legal counsel, copyright@aia.org. 061110
* OLD REPUBLIC INSURANCE COMPANY
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That OLD REPUBLIC INSURANCE COMPANY, a Pennsylvania stock insurance corporation, does make,
constitute and appoint:
NICOLE L BICKNELL, MEGAN E RIESENBERG, MARK EDWARD WOBBE, BARBARA E PEARSON, JENNIFER L KASZNIA, SANDRA L JUNK, WILLIAM J CERNEY, III,
WESLEY MANTOOTH, THERESA BURNS, JORDAN SCHEIBER, LISA M THOMAS, FAITH HUNT, PAMELA S. HIGGINBOTHAM of SOUTH BEND, IN
its true and lawful Attorney(s)-in-Fact, with full power and authority for and on behalf of the Company as surety, to execute and deliver and affix the seal of the
Company thereto (if a seal is required), bonds, undertakings, recognizances or other written obligations in the nature thereof, (other than self-insurance workers
compensation bonds guaranteeing payment of benefits, or black lung bonds), as follows:
ALL WRITTEN INSTRUMENTS IN AN AMOUNT NOT TO EXCEED TWENTY MILLION ($20,000,000) FOR ANY SINGLE OBLIGATION
and to bind OLD REPUBLIC INSURANCE COMPANY thereby, and all of the ads of said Attorneys -in -Fact, pursuant to these presents, are ratified and
confirmed. This appointment is made under and by authority of the board of directors at a meeting held on December 10, 2019, This Power of Attorney is signed
and sealed by facsimile under and by the authority of the following resolutions adopted by the board of directors of the OLD REPUBLIC INSURANCE
COMPANY on December 10, 2019,
RESOLVED FURTHER, that the chairman, president or any vice president of the Company's surety division, in conjunction with the secretary of any
assistant secretary of the Company, be and hereby are authorized and directed to execute and deliver, to such persons as such officers of the Company
may deem appropriate, Powers of Attorney in the form presented to and attached to the minutes of this meeting, authorizing such persons to execute and
deliver and affix the seal of the Company to bonds, undertakings, recognizances, and suretyship obligations of all kinds, other than bail bonds, bank
depository bonds, mortgage deficiency bonds, mortgage guaranty bonds, guarantees of installment paper and not guaranty bonds. The said officers may
revoke any Power of Attorney previously granted to any such person,
RESOLVED FURTHER that any bond, undertaking, recognizance, or suretyship obligation shall be valid and binding upon the Company
(i) when signed bychairmen, president or anyvice president of the Company's surety division and attested and sealed (if a seal be required) byany
secretary or assistant secretary; or
(it) when signed by a duly authorized Attorney -in -Fact and sealed with the seal of the Company (if a seal be required).
RESOLVED FURTHER, that the signature of any officer designated above, and the seal of the Company, may be affixed by facsimile to any Power of
Attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the
Company, and such signature and seal when so used shall have the same force and effect as though manually affixed.
IN WITNESS WHEREOF, OLD REPUBLIC INSURANCE COMPANY has caused these presents to be signed by its proper officer, and its corporate seal to
be affixed this 30th day of November 2022
QA�,�S a of OLD REPUBLI SUP/AA I E COMPANY
SEAL €`
A I I saoret�.� Vice President
STATE OF WISCONSIN, COUNTY OF WAUKESHA- SS""v°ram
On this 30th day of November 2022 ,personally came before me, Alan PavlfC
and Karen J. Haffner , to me known to be the individuals and officers of the OLD REPUBLIC INSURANCE
COMPANY who executed the above instrument, and they each acknowledged the execution of the same, and being by me duly sworn, did severally depose
and say: that they are the said officers of the corporation aforesaid, and that the seal affixed to the above instrument is the seal of the corporation, and that said
corporate seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority of the board of directors of said
organization.
q;pUa4�G,: Notary Public
My Commission Expires: September 28, 2026
CERTIFICATE (Expiration of notary's commission does not invalidate this instrument)
I, the undersigned, assistant secretary of the OLD REPUBLIC INSURANCE COMPANY, a Pennsylvania corporation, CERTIFY that the foregoing and
attached Power of Attorney remains in full force and has not been revoked; and furthermore, that the Resolutions of the board of directors set forth in the
Power of Attorney, are now in force.
���' µeVvut't'e%,
_¢ SEAL 8 _ Signed and sealed at the City of Brookfield, WI this 3rd day of AU�,Ust 2023 ,
45-5314
ORSC IInnis (G93) uana A�s Islam Seat I; y
GIBSON INSURANCE AGENCY, INC.
M _ �._
s9+ • 1,• • 44
The Times -Mail I Evening World
The Reporter Times
PROOF Or PUBLICATION
Staci Froman Froman
Premium Services
712 Richmond ST
Elkhart IN 46516-3785
STATE OF INDIANA, COUNTY OF ST JOSEPH
The South Bend Tribune, a newspaper printed and published in
the county of St Joseph, in the State of Indiana, and personal
knowledge of the facts herein state and that the notice hereto
annexed was Published in said newspaper in the issue dated:
07/30/2023,08/03/2023
and that the fees charged are legal.
Sworn to and subscribed before on 08/03/2023
My commision expit'es
Publication Cost: $88.62
Order No: 9100603
Customer No: 1020398
PO #:
THIS IS NOT AN INVOICE!
Please do non�.re this form j r pgymeoi reruluauce.
• i.
State Iof
# of Copies:
BID NOTICE
SEEKING MBE/WBE
Subcontractors
Premium Concrete Services,
Inc. DBA Premium Services,
an EEO Employer, is seeking
proposals from qualified
MBE/WBE subcontractors and
suppliers for the following
proiect: Cleveland &
Ameritech Intersection
Improvements, Proiect No.
122-049 for the City of South
Bend. All proposals must be
received prior to 2:OOPM on
Monday, August 7th, 2023.
Anyone interested in bidding
on this proiect please call:
t574) 264-0196 or email:
rbecker@premi umservices.gro
up for plans and specifications.
Hspaxlp 2x 7:30 8:3
Page 1 of 2
316 COUNTY -CITY BUILDING
227 W. JEFFERSON BOULEVARD
Sovrn BEND, INDIANA 46601-1830
PiioNr: 574/235-9251
Enx 5741235-9171
TDD 574/235-5567
BOARD WORKS
Date: August 2, 2023
To: All Planholders
From Theresa Heffner, Cl(
Subject Addendum Number:
Project Name:
Board of Public Worlcs
1
Cleveland Rd & ,4meritech Dr Intersection Improvements
Project Number: 122.049
by faxing this sheet to the Board of Public Works at (574) 235-9171
within 48 hours of receipt. A copy MUST also be included with your
bid package upon submittal.
The attached documents are hereby added to the Specil"ications and Contract
Documents and become a part of herein.
Authorized Signature:
Date:
Version 4/2/2015
1316 COUNTY -CITY BUILDMG
227 W..IEEFIERsoN BOULEVARD
SOUT] I BEEN, INDIANA 46601-1830
PeoNe 574/235-9251
C'nx 574/ 235-9171
TDD 574/ 235-5567
CITY OFSW"rH BEND JAMGS MUELLER, MAYOR
BOARD OF PUBLIC WORKS
Date: August 18, 2023
To: All Planholders
Prom Theresa Heffner, Cl(
Subject Addendum Number:
Project Name:
Project Nwnber
Board of Public Works
2
Cleveland Rd &Ameritech Dr Intersection Improvements
Date Received: � ���1z3
Please sign below and acknowledge receipt of this Addendum
by faxing this sheet to the Board of Public Works at (574) 235-9171
within 48 hours of receipt. A copy MUST also be included with your
bid package upon submittal.
The attached documents are hereby added to the Specifications and Contract
Documents and become a part of herein.
Company:
Authorized Signature:
�'nvr�„� Con1G2CTE SDK✓scE
i
Date:
Version 4/2/2015
1316 COUNTY -CITY BUILDING
227 W. JEFFERSON BOULEVARD
SOUTH BEND, INDIANA 466014830
PHONE 574/235-9251
FAx 574/235.9171
TDD 574/ 235-5567
CITY OF SOUTH BEND DAMES MUELLER5 MAYOR
BOARD OF PUBLIC WORKS
Date: August 18, 2023
To: All Planholders
From Theresa Heffner, Clerk, Board of Public Works
Subject Addendum Number: 3
Project Name: Cleveland Rd & Ameritech Dr Intersection Improvements
Project Number: 122-049
Date Received:
This addendum is being forwarded to you for the above referenced project.
Please sign below and acknowledge receipt of this Addendum
by faxing this sheet to the Board of Public Works at (574) 235-9171
within 48 hours of receipt. A copy MUST also be included with your
bid package upon submittal.
THIS ADDENDUM M.��' ��'1FP�T, `�'®UJhR 1[�1JI�.
Notes:
The attached documents are hereby added to the Specifications and Contract
Documents and become a part of herein.
Company:
Authorized Si
Date:
Version 4/2/2015
CITI OF BEnD,Tl1D1A11A
• •' •� •'
Project Name Cleveland Rd &Ameritech Dr Intersection Improvements
Project No. 122-049
For Bids Due August 8, 2023
Contractor Name: Premium Concrete Services 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. 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 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
s 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 10/13/2021 General Conditions - 10
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 (i.e.. 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 10/13/2021 General Conditions - 12
II. PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED)
(a) Acknowledgements:
By checking this box, I hereby acknowledge that I am not apre-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.
(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 (i.e.. 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 Safely 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 10/13/2021 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.
Date:
& At
(Sign ere)
Austin Reddinc
(Print Name Here)
Premium Concrete Services Inc.
(Name of Company)
712 Richmond Street
(Address of Company)
Elkhart
(City)
Indiana
(State)
574-264-0196
(Telephone Number)
Version 10l13/2021 General Conditions - 14
CITY OF SOUTH BEND TAMES MUELLER, MAYOR
DEPARTMENT OF PUBLIC WORKS
ERIC HORVATH, DIRECTOR
May 30, 2023
Rob Becker
Premium Concrete Services
becker@premiumconci,eteonline.com
RE: Pre -Qualification Verification
Dear Mr. Becker:
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 $150000
submitted to the City of South Bend Board of Public Works, along with your Pte-Qualified
Bidder Checklist and attachments.
If you have any further
questions
regarding this
matter, please call this office at (574) 235-
9251.
Sincerely,
-k,1�,��
Theresa Heffner
Board of Public Works, Clerk
�, MMUMINIA
•,
Certified Copies
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 this is a true and complete copy of this 4 page document consisting of the
following records filed in this office:
Certification Date: May 22, 2023
Business Name: PREMIUM CONCRETE SERVICES, INC.
Business ID: 2004120100105
Transaction Date Filed � No, of pages
Business Entity Report 09/06/2022 2
Certificate of Assumed Business Name 10/12/2022 2
Total No of pages 4
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 220 2023
V '
li]IXC1.7JI[l7L11110
2004120100105 / 15712440
All certificates should be validated here: https://bsd.sos.in.gov/ValidateCertificate
Expires on June 21, 2023,
Page (Of 5 Ceiiifica[eID:15712440
APPROVED AND FILED
HOLLI SULLIVAN
iINDIANASECRETARY OF STATE
09/06/2022 02:25 PM
NAi4iC!�",AND=i' CIPAI. OE'I'+,1.G�ADORES
BUSINESS [D 2004120100105
BUSINESS TYPE Domestic For -Profit Comoration
BUSINESS NAME PREMIUM CONCRETE SERVICES, INC.
ENTITY CREATION DATE 11/24/2004
JURISDICTION OF FORMATION Indiana
PRINCIPAL OFFICE ADDRESS 712 RICHMOND ST. ELIOIART, IN, 46516, USA
YEARS
GFFEC'I'1VE DACE
EFFECTIVE TIME
REGISTE12Ell AGENT TYPE
NAME
ADDRESS
2022/2023
09/O6/2022
2:25 PM
Individual
MAX A. YEAKBY
712 Richmond Street, Elkhart, IN, 46516, USA
TITLE President
NAME Becky L. Yeakey
ADDRESS 712 Richmond Street, Elldiart, IN, 46516, USA
'1'1TLF. Vice President
NAME hoax A. Ycakey
ADDRESS 712 Richmond Street, Elkhart, IN, 46516, USA
Pnge 2 Of 5 CcrtificatelD:IS712440
-Page 1 of 2 -
APPROVED AND TILED
HOLLI SULLIVAN
INDIANA SECRETARY OF STATE
09/06/2022 02:25 PM
IN WITNESS WHEREOF, Tt-IE UNDERSIGNED HEREBY VERIFIF,S, SUBJECT TO THE PF,NALTIFS OF PERJURI', THAT THE
STATEMENTS CONTAINED HEREIN ARETRUE, THIS DAY September 6, 2022.
THE UNDERSIGNED ACKNOWLEDGES THAT A PERSON COMMITS A CLASS A MISDEMEANOR BY SIGNING A
DOCUMENT THAT THE PERSON KNOWS 1S FALSE IN A MATERIAL RESPECT WITH THE INTENT THAT THE DOCUMENT
BE DELIVERED TO THE SECRETARY OF STATE FOR FILING.
SiGNA'PI7RE /s/ Matthew A. Yeal<ey
TITLE Legal Representative
Business ID : 2004120100105
Filing No.: 9549531
Page 3 Of 5 Certif catelD a 57 L2440
-Page2of2-
•' r
Certificate of Assumed Business Name
of
• "1? x � 'l r Fyn ',
I, HOLLI SULLIVAN, 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:
PREMIUM SERVICES
NOW, THEREFORE, with this document I certify that said transaction will become effective Tuesday,
October 11, 2022,
In Witness Whereof, I have caused to be affixed my
signature and the seal of the State of Indiana, at the City of
Indianapolis, October 12, 2022.
HOLLI SULLIVAN
SECRETARY OFSTATE
2004120100105 /9591594
To ensure the certificate's validity, go to https://bsd.sos.in.gov/PublicBusinessSearch
Yage 4 Of S CertificateID:15712440
BUSINESS ID
BUSINESS TYPE
BUSINESS NAME
PRINCIPAL OFFICE ADDRESS
ERREC'I'IVE DATE
EFFECTIVE TIME
Premium Services
APPROVED AND FILED
HOLLI SULLIVAN
INDIANA SECRETARY OF STATE
10/12/2022 08:45 AM
2004120100105
Domestic For -Profit Corporation
PREMIUM CONCRETE SERVICES, INC.
712 RICHMOND ST. ELKHART, IN, 46516, USA
10/I I/2022
04:58PM
712 Richnwnd Street, Elldrart, [N, 46516, USA
IN WITNESS WHEREOF, THE UNDERSIGNED HEREBY VERIFIES, SUBJECT TO THE PENALTIES OF PERJURY, THAT THE
STATEMENTS CONTAINED HERP.IN ARE TRUE, THIS DAY October 11, 2022.
THE UNDERSIGNED ACKNOWLEDGES THAT A PERSON COMMITS A CLASS A MISDEMEANOR BY SIGNING A
DOCUMENT TI-IAT Ti IE PERSON KNOWS IS FALSE IN A MATERIAL RESPECT WITH THE INTENT THAT THE DOCUMENT
BE DELIVERED TO THE SECRETARY OF STATE FOR FILING.
SIGNATURE
TITLE
Saulo 1. Delgado
Legal Representative
Business ID : 2004120100105
Filing No.: 9591594
Page 5 Of 5
CertificatelD:15712440
-Page 1 of 1 -
z
z0
a
-
v
0
F
_
Ik
pa
�
<
n
0
w
<
0
n
n
3
3
F
F
_
_
_
v
£
3 3
3
Ro
3
Ro
R�
v
w
v
o
=
v
v
w
ti
F
£
F
£
F
F
£
F
3
R-39514 LaSalle & Marquette
500111 Bend
INDOT
$ 210,779.59
Sldewalk, ADA compliant
1902
T-40016-A Traffic Signals
Ft, Wayne
INDOT
$ 199,735,00
Curb, curb & gutter, sidewalks, HMA patching,
PCCP patching, curb ramp,
1914
detectable warning surfaces
South Bend Waterworks
South Bend
City of South Bend
$ 79,121.00
Various concrete/asphalt utility repair wm'k
1936
R-40913 Howe,IN5R12
Howe
IIVDOT
$ 57,989.85
Concrete A substructure, Cuncrete B footings,
reinforcing bars epoxy coated.
1929
Cityof Elkhart Various
Elkhart
Cityof Elkhart
$ 70,171,85
Various concrete curb, sidewalk &sitework
1904
Premium Concrete Services, Inc
712 Richmond St.
Elkhart, IN 46516
574-264-0196 fax 574-266-5392
05/23/2023
To Whom it may concern,
Premium Concrete Services, Inc. currently employs 56 people, 8 of which are field
supervisors, 9 concrete finishers, 19 laborers and 6 heavy equipment operators.
We are signatory to the local Cement Masons, Laborers and Operator's unions
through which extra employees can be pulled from when needed.
Max Yeakey
V.P.
Premium Concrete Services, Inc.
dba Premium Services
712 Richmond Street
Elkhart, IN 46516
574-264-0196 fax 574-266-5392
May 23, 2023
To Whom it May Concern,
Premium Concrete Services, Inc. has never been identified by any other business name in the
past. As of October 12, 2022, as filed with the Indiana Office of the Secretary of State, Premium
Concrete Inc. also conducts business as Premium Services,
Max Yeakey
Vice -President
Premium Concrete Services, Inc.
dba Premium Services
712 Richmond Street
Elkhart, IN 46516
574-264-0196 fax 574-266-5392
May 23, 2023
To Whom it May Concern,
Premium Concrete Services, Inc, has no violations of federal, state, or local laws, nor have there
been any violations in the past.
Max Yeakey
Vice -President
05/23/2023 11:15 All FAX 8122795545 ILTI FAX
r�oo02/0008
INDIANA LABORERS' TRAINING TR UNT,FUND
avid A. Frye
Secretary- Treasurer
Jerty J Bolk
Chris Brickcy
Ricky Henson, Jr,
Ramon Mendoza, Jr,
Brian Short
P.O. Box 758 - BedFord, Indiana 47421
(812)279-9751
May 23, 2023
To Whom It May Concern:
Sean Coakley, Director
Jnl�a P. Brown
Chairman
Kelly Abel
Michael Perrara
Sran Meyer
Nick Timmerman
Ji»t Wiseman
FAX: (812) Z79-5545
Toll Free (800) 742-4086
This letter is to confirm that "Yreminnr C:oncretc Services, Inc." f5 a signatpry CUntraClOY in
good standing with the Indiana Laborers' Training Trust Fund,
'fhe above -mentioned company is a participant in the Joint Apprenticeship and Training
Committee through this Union and has been an active participant in good standing for each of the
past five plus consecutive years, and is currently eligible to use our apprentices on a project.
Fut•ther, our organization's program is approved by the U.S. Veterans Administration to
participate in the CrT educational benefits program. A copy of our approval letters are attached
along with the collective bargaining agreement stating the ratios of Journey workers to
Apprentices; which is one (1) Apprentice for every five (5) Journey workers and thereafter may
not employ more that (1) Apprentice for every (3) Journey workers.
Sincerely,
Sean Coakley,
Director
SC:ap
www. irtdlanalaborertvh•uinin�, nr•Q
DIANA LABORER`S TRAINING TRUST FUND
BEDFORD, IiiDIANA
for tha trade classification of CONSTRIICTIflN CRAI'T LABOREP.
.I�eyisfered'( as parf of l.�ze .�afiona� .`�pprenfiees�rp J ror_Pram
in accoro�ance wilhr f e basic sfano�aros o� apprenl ces tip
eslabfi's&o( Sy fhe 6ecrefary o� Labor
December i4, 1995
Det
IN040-0528
.T y=&Vzon moo.
«� 1
a�:y_ �rraso.
^L•i�crmr Bi ,auofC4ISp-m=i - !( wdg=zo'
05/23/2023 11:16 AM FAX 8122795545
ILTI FAX
I�JOG04/0008
STATE OF INDIANA
DEPARTMENT OF VETERANS AFFAIRS
STATE APPROVING AGENCY
A02 WEST WASHINGTON STREET ROOM W-460
INDIANAPOLIS, INDIANA 46204-2738
Jeremy $rower
Apprenticeship Coordinator
Indiana Laborers Training Trust Fund,Apprenticeship
439 Patton Hill Rd,
Bedford, IN 47421
Dear Jeremy 13rcwer,
Eric Holcomb, Governor
James M. Brown, Diroctor
January 9, 2019
The Indiana State Approving Agency conducted a supervisory visit on O]/8/2019 al Indiana
Laborers Training Trust FunrhApprenticeship. The purpose of the visit was to provide training to
the Certifying Officials and review enrollment certifications, record retention and reporting
procedures.
The organization demonstrated proper record maintenance and record maintenance and reporting
procedures: During the visit, we discussed the .importance of reporting hours on a monthly basis,
good record keeping techniques, and how to report a leave of absence or completion via VA Form
22-1999b. We also updated (lie Certifying Officials via VA Form 22-8794, work processes, and
wage scale,
if you need any assistance or have any questions regrading this teclnrical visit please contact me
directly at lgziffnl(cv dva.in.gov or (317) 232-3916. Thank you for the courtesy extended during my
visit. The education and training opportunities that your organization continues to provide veterans
and their dependents are appreciated.
Sincerely,
Ta,tiqua Griffin
Program. Director
Yhonn(317)-234-6062 ToIII•'ree(800)-400.4520 Fax (317)-234-ft744
05/23/2023 11:16 AM FAX 8122795545 ILTI FAX 0 0005/0008
STATE OF INDIAN
DEPARTMENT OF VETERANS AFFAIRS
STATE APPROVING AGENCY
402 WEST WASHINGTON STREET ROOM W469
INDIANAPOLIS, INDIANA 46204.2738
Jercmy Brewer
Apprenticeship Coordinator
Indiana Laborers Training Trust Fund -Apprenticeship
439 Patton Hill Rd,
Bedford, IN 47421
Dear Jeremy Brewer,
Eric Holcomb, Governor
JamUS M. Brown, Director
January �, 2019
This wi11 acknavvledge receipt of your updated 'Wage Seale for the ConstrueHora Craft Laborer progrtuxz
offered by Indiana Laborers Training Trust Find -Apprenticeship, The State Approving Agency has reviewed
the document as listed below:
Wagc Scale: Constructiou Craft Laborer
FA,C1L1'1'Y CODE: 30004114
To the best n['my larowlcdge Indiana Laborers Training Trust fund -Apprenticeship does not utilize er-raneous
or misleading advertisement, either by actual statement, omission, or intimation, It is understood by Indiana
Laborers Training Trust Find -Apprenticeship that they will maintain a complete record of all advertising
utilized by or on behalf of the Indiana Laborers Training Trust Fund -Apprenticeship in regards to their
training programs during the preceding 12 montbs. Indiana Laborers Traiiing '1•rust Fun&Apprenticeship`s
advertising will be available for review by any and all future supervisory visits by the SAA, or the U.S.
Department of Veteran Affairs,
Please Review the entire packet far content and accnracy..A.pproval is granted pursuarrt to the provisions of
Title 3S, T1.S. Code 36&7, with an e:Pfective date of April 1, 2018.
If
you have any questions, please feat ii•ee to give me a call at 317-232-3916 or email me at
tgriffm rr dva.in,gov. Thank yott fct whtit you do for otu• Veterans, and have a great day!
Sincerely,
'1'aniqua Griffin
Program Director
State Approving Agency
Cc: VAR0/h.'t,R.
STq
�AAn�D�IN� if
05/23/2023 11:17 AM FAX 8122795545 ILTI FAX Z 0006/0008
STATE OF INDIANA
DEPARTMENT OF VETERANS AFFAIRS
STATE APPROVING AGENCY
402 WEST WASHINGTON STREET ROOM W-469
INDIANAPOLIS, INDIANA 46204-2738
7ezemy Brewer
Apprenticeship Coordinator
Indiana Laborers Training Trust Fwxd-Apprenticeship
439 Patton Mill Rd.
Bedford, IN 47421
Dear Jeremy Brewer,
Eric hlolcomb, Governor
James M. Brown, Director
January 9, 2019
This will acicnowledgc receipt of yoLu revised VS'ork Processes for the Construction Craft
Laborer program offered at Hoosier Energy, located in Bedford, Indiana. The State Approving
Agency has reviewed the document as listed below:
T1tA.TN1IVG PROGRAM LENC,TII Dp`C CODL
Czrnstructicm Craft Laborer
FACILI'I'X CODH: 30004114
4,000-7800 how's 47�2061.00
To #}z.e best of my knowledge ludiana Laborers Traizung Trust Farad -Apprenticeship does nol utilize
erroneous or misleading advertisement, either by actual statement, omission, or intimation. It is
understood by Indiana Laborers TraWng'TI•ust Paid -Apprenticeship that they will maintain a
complete record' of all advertising utilized by or on behalf of the company in regards to their training
programs during the preceding 12 months. T'he company's advertising will be available for review
by any and all future supervisory visits by the SAA, or the U.S. Department of Veteran Affairs.
This approval is made pursuant to and under the provisions of Title 38, U. S. Code 3687, with an
effective date of Jaunary 8, 2019.
If you have any questions, please contact me at 317-232-391.6.
Sincerely,
s�
Taitigna Griffin
Program, T�irector
State Approving Agency
Cc: VARO/FJ.R
Phono (317)-234-60t2 'roll Frce (800)-000-4.520 Fax (377)-234-R744
05/23/2023 11:17 AM FAX 8122795545 ILTI FAX
9007/0008
Apprentice Status Report By Indenture Date
Apprentices Indenlared Between 1/1/2018 And 7/13/2022
Apprentice Program: IN2
Year Apprentice Status Apprentices Percentage
2018
2019
Reinstate'".. .;
Suspended
Termlltated .'
Voluntary withdraw
Total indentured
2
5
p.59
71
$i4D.:%
10
1.18
Z
0,24°A
i
0,12 %
7
0,83
38
4,50 %
845
Adv, to Journeyman
72
7.70 %
Deceased
Graduated
51
5.45 eh
Inactive .,
11
" 1,1$
Journeyman
12
1.28
h1etl::5usp:.. ..
4.,.PF
, .
Reinstate
15
1.60 %
SUspi de¢F
F F.3
Q . ,32 °(o.
Terminated
528
56,97 %
Voluntary withdraw P,68
7.27
Total Indentured 935
noted: Wednesday, July 73, 2022 Page r of 2
05/23/2023 11:17 Au FAX 8122795545 ILTI FAX
0008/0008
Apprentice Status Report By Indenture Date
Apprentices Indentured Between 1/11201 a And 7/13/2022
Apprentice Program: IN2
Year Apprentice Status Apprentices Percentage
11.1
2020
2021
F
242
;...:' 70
Adv. to Journeyman
33
4195
Receased I IF 12
0l30 d%
Graduated
3
0.45 %
7ourneYman ::
IF I
1.
OAS °fa'
Med. Susp.
4
0,60
IF IFF
4 1
I....: . 015%
Reinstate
12
1,80 %
Suspended
FogFjF. 3
1..I:: F . 0 45 %
Terminated
329
49.33
voluntarywithdraw
37
5i35 %
Total Indentured 667
Active Duty
1
0,13 %
Adv: t0 Journeyman IF
I I
.. 2:9T%
Deceased
2
0.26 %
Metl, Susp:. ....
3.
0IF IF.39 %
Reinstate
20
2.58
Suspended
" . 2
0 1 In2&:%
IF
Terminated
220
28,39
..... ..
Voiunlarywi_tHrauq ..
32.;,.;..
4. . %u
_
Total Indentured 775
Adv. to Journeyman
4
0,65 %
graduated_ 'I IF
IF1:
0416 %
Med. Susp.
2
0.32 %
Not keyiskered.IFI
0.813°.
Reinstate
331
5,32 %
Terminated. ':
32
5.16 Y°
Voluntary withdraw
5
0,81 °/
Total Indentured 620
Printed: Wr:dnesdny, July 13. 2022 page 2 0/ 2
Plasterers & Cement Masons'
Apprenticeship Coordinator Local Union #692
To Whom it May Concern:
Phone: km) tv,-, 67
Email: bkristoff@plcmlocal692.org
May 23, 2023
This letter is to certify that Premium Services, Inc. is and has been a signatory
contractor with OPCMIA Local 692 and has participated in the Plasterers &
Cement Masons Apprenticeship Training Program for many years. Premium
Services Inc. is a valued Contractor in good standing with Local 692 and the JATC.
All our apprentices are registered with the United States Department of Labor.
I may be reached at (219) 707-7767 if additional information is needed.
Further, our organization's program
is
approved
by the U.S. Veterans
Administration to participate in the
GI
Education
Benefit Program.
Thank you,
Brian Kristoff
Apprentice Coordinator
Plasterers & Cement Masons
9200 Louisiana Street Merrillville, Indiana 46410
WWW.PLCMLOCAL692.ORG -_
Plasterers & Cement Masons'
Apprenticeship Coordinator Local Union #692
Local 692 Apprenticeship Summary
Year
15Y
2"d
3`d
NEW
Grads
Total
2016
31
14
26
25
3
71
2017
35
20
21
61
20
76
2018
30
36
19
52
16
85
2019
30
26
16
13
13
78
2020
30
34
22
52
15
86
2021
25
28
23
16
12
76
2022
22
35
36
35
10
93
Phone: kMI im-7767
Email: bkristoff@plcmlocal692.org
9200 Louisiana Street Merrillville, Indiana 46410
WWW.PLCMLOCAL692.ORG
4.
elm
'm.� Sr' yicy
Y' t, t
1- 2 E ru =e' I 7"y'Sr q -iS a �"i? . , I ,� +4n,
'I xis r s ! h F.
t `p\ r" 3t S?cy�{�y^ k.S"-mJr +t a y i{ iS r!'+�y�,�yl �1 -c R��..-r-.- �`'� :,,. ,;k tir. ,.,�- :-I`�`"..,�.e -�,`"� E v ,f3 YE _-,2p bg 1 d I
'`.,. ^�,m.. �,T�.0 G- .om c�E����i C t'•,'�*z��'P`<, � ._ .-'ar .wrr .r-s. 3 -may.
NAI mil*. f ._� L
r OF THE TRADE G_F.SS't �'-CAT: GIIS: Cam:+.�t�NT n4,ASGIy; P'_,4STERE''
227
i'3J 1 095CJ'DJ
PREMIUM CONCRETE SERVICES, INC.
Elkhart, Indiana
DECEMBER 31, 2022
TABLE OF CONTENTS
Page
Number
INDEPENDENT ACCOUNTANTS' REVIEW REPORT .............................................. 1
FINANCIAL STATEMENTS
BalanceSheets.................................................................................................... 3
Statements of Income and Retained Earnings...................................................... 5
Statements of Cash Flows.................................................................................... 6
Notes to the Financial Statements........................................................................ 7
SUPPLEMENTARY INFORMATION
Schedule I — Direct and Indirect Contract Costs.....................4............................. 13
Schedule II — General and Administrative Expenses ............................................ 14
CP A u-KIuuP L L P
INDEPENDENT ACCOUNTANT'S REVIEW REPORT
To Management
PREMIUM CONCRETE SERVICES, INC.
Elkhart, Indiana
We have reviewed the accompanying financial statements of PREMIUM CONCRETE SERVICES, INC. (an
S corporation), which comprise the balance sheet as of December 31, 2022, and the related statements of
ncome and retained earnings and cash flows for the year then ended, and the related notes to the financial
statements. A review includes primarily applying analytical procedures to management's financial data and
making inquiries of company management. A review is substantially less in scope than an audit, the objective
of which is the expression of an opinion regarding the financial statements as a whole. Accordingly, we do
not express such an opinion.
Management's Responsibility for the Financial Statements
Management is responsible for the preparation and fair presentation of these financial statements in
accordance with accounting principles generally accepted in the United States of America; this includes the
design, implementation, and maintenance of internal control relevant to the preparation and fair presentation
of financial statements that are free from material misstatement whether due to fraud or error.
Accountants' Responsibility
Our responsibility is to conduct the review engagement in accordance with Statements on Standards for
Accounting and Review Services promulgated by the Accounting and Review Services Committee of the
AICPA. Those standards require us to perform procedures to obtain limited assurance as a basis for reporting
whether we are aware of any material modifications that should be made to the financial statements for them
to be in accordance with accounting principles generally accepted in the United States of America. We believe
that the results of our procedures provide a reasonable basis for our conclusion.
We are required to be independent of PREMIUM CONCRETE SERVICES, INC, and to meet our other ethical
responsibilities, in accordance with the relevant ethical requirements related to our review.
Accountants' Conclusion
Based on our review, we are not aware of any material modifications that should be made to the
accompanying financial statements in order for them to be in accordance with accounting principles generally
accepted in the United States of America.
Report on 2021 Financial Statements
The financial statements of PREMIUM CONCRETE SERVICES, INC. as of December 31, 2021, were
reviewed by another accountant whose report dated February 24, 2022, stated that based on his procedures,
he is not aware of any material modifications that should be made to the financial statements in order for them
to be in accordance with accounting principles generally accepted in the United States of America.
(1)
Cornerstone ChA Group LL6' � 3aG0 V�tindsor CourC = Elkhart, IN 46514 d phone 57�l-767-8f3S6 or 574-296-9360
Supplementary Information
The supplementary information included in Schedules I and II is presented for purposes of additional analysis
and is not a required part of the basic financial statements. Such information is the responsibility of
management and was derived from, and relates directly to, the underlying accounting and other records used
to prepare the financial statements. The supplementary information has been subjected to the review
procedures applied in our review of the basic financial statements. We are not aware of any material
modifications that should be made to the supplementary information. We have not audited the supplementary
information and do not express an opinion on such information.
CORNERSTONE CPA GROUP, LLP
Certified Public Accountants
Elkhart, Indiana
June 26, 2023
�2)