HomeMy WebLinkAboutOpening of Bids - Demo 1000 W. Sample St. (Former Fun FX Bldg.) Proj No. 123-014 - C. Lee Constructionr.
BID/PROPOSAL �w
CITY OF SOUTH BEND
Project Name: Demolition of 1000 West Sample Street �>ag.-
Project Number: 123-014
For Bids Due. Tuesday, February 13, 2024 @ 9:00 A.M. (E.S.T.)
Contractor Name: C. Lee Construction Services, Inc.
Item
No. Description Quantity Unit Unit Price Total Amount
Provide a Lump Sum price to
1 perform the demolition, backfill, 1 LSUM
grading and seeding as intended 1,099,920.00 $ 1,099,920.00
by these Specifications
Bidder (Firm): C. Lee Construction Services, Inc.
Address: 1011 S. Lake St.
City/State/Zip: Gary, IN 46403 Telephone Number,
By
Total Amount of Bid I $ 1,099,920.00
`(Signature)
Frederick Lee, President
(Printed Name of Person Signing)
Version 07/ 19/2023 Contractor's Bid for Public Works - 7
F4
P kcr',
CITY OF SOUTH BEND, INDIANA 1e�ti'
CONTRACTOR'S BID FOR PUBLIC WORK
CHECKLIST FOR BIDDERS
Project Name Demolition of 1000 West Sample Street
Project No. 123-014
For Bids Due Tuesday, February 13, 2024 @ 9:00 A.M. (E.S.T.)
From time to time the South Bend Board of Public Works finds it necessary to reject a bid because
it does not comply with statutory requirements. In preparing your bid, please use the following
checklist in order to make sure that your bid is done in the proper manner.
Proper bid security included. The bidder has the option of providing either a Certified Check
or Bid Bond.
Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely
executed.
Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments
with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and
V Certification of use of United States Steel Products or Foundry Products.
Proof of M/WBE Utilization Plans [MBE-1.0 and WBE-1.01. Also provide Evidence of Good
Faith Efforts Forms [MBE-2.0 and WBE-2.01 and M/WBE Contacted Forms [MBE-2.1 and
V WBE-2.1].
V Acknowledge Receipt of 1 Addendum(s) included with the bid.
✓ All required additional information is included with the bid.
Proposal statements and other affidavits all signed by the proper party with name either
printed or typed underneath signature.
This checklist submitted with the Bid.
This checklist is provided for bidder's use in assuring compliance with required
documentation; however, it does not include all specifications requirements and does not
relieve the bidder of the need to read and comply with the specifications.
Bidder: C. Lee Construction Services, Inc.
By Authorized Representative:
Signature:
Print Name & Title:
, President
Date: 2-12-24
Version 07/19/2023 Contractor's Bid for Public Works -1
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
Project Name Demolition of 1000 West Sample Street
Project No. 123-014
For Bids Due Tuesday, February 13, 2024 @ 9:00 A.M. (E.S.T.)
PART I
(Must be completed for all bids. Please type or print)
Date: 2-12-24
Address: 1011 S. Lake St.
City/State/Zip:
Gary, IN 46403
Bidder (Firm): C. Lee Construction Services, Inc.
Telephone Number: 219 888-9554
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:
Demolition of 1000 West Sample Street — Former Fun FIX Buiidin
the City of South Bend, Indiana, in accordance with plans and specifications prepared by:
City of South Bend, Engineering Division
and dated 01/26/2024 for the sum of (enter the Total Bid as shown on the Proposal)
One Million, Ninety Nine Thousand, Nine Hundred Twenty Dollars and Zero Cents. ($ 1,099,920.00 )
(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 nits must be the same as that
shown in the original contract if accepted by the City of S Ben the bid is to be awarded on a unit
basis, the itemization of the units shall be shown on a sepa a e+rrrf�
By
(Signature)
Frederick Lee, President
(Printed Name 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
day of
20
Joseph R. Molnar, Vice President
Breana N. Micou, Member
Murray L. Miller, Member Attest: Theresa Heffner, Clerk
Version 07/19/2023 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. Attached
2. Attach a listing of public works projects currently in process of construction by your
organization. Attached
3. Attach information regarding any failure to complete any work awarded to you and the
location thereof. N/A
4. Attach references from private firms for which you have performed work. Attached
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.) Attached
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.
Attached
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. Attached
4. Attach a listing of equipment you have available to use for the proposed project. Attached
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. Yes
SECTION Ill 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. Attached
Version 07/19/2023 Contractor's Bid for Public Works - 3
Contractor's Bid For Public Work
Part II
Section 1 Experience Questionnaire, Item No. 1
Project completed for the period of one (1) year prior to bid date
Project Name
Contract Amount
Class of Work
Completion Date
Project Owner & Contact
Information
Westville Prison Demolition
$
1,405,800.00
Demolition
January 2024
Build Westville, Brad Krueger Phone
(517) 242-0306
INDOT 33678 Indy Blvd
$
1,460,000.00
Grading / Site Prep
January 2024
Rieth-Riley, Dan McClure (219)
671-3323
Miller Station
$
654,000.00
Demolition
January 2024
Masse Construction, Jeff Jackman
(708) 473-3321
Walsh Double Track
$
4,742,200.00
Demolition
December 2023
Walsh Construction, Kevin Kegevein
(312) 656-0853
Westville Trailer City
Parking Lot
$
718,000.00
Parking Lot
December 2023
Build Westville, Brad Krueger Phone
(517) 242-0306
INDOT 41441 Cline Ave
$
815,000.00
Grading / Site Prep
September 2023
Rieth-Riley, Dan McClure (219)
671-3323
Double Track Southshore
Expansion
$
898,500.00
Demolition
March 2023
NICTD, Tony Siegmund
(219) 874-4221
West Lake Southshore
Expansion
$
1,143,700.00
Demolition
March 2023
NICTD, Tony Siegmund
(219) 874-4221
Contractor's Bid For Public Work
Part 11
Section 1 Experience Questionnaire, Item No. 2
Public Works Projects Currently in Process
Project Name Contract Amount Class of Work Completion Date Project Owner & Contact
Information
406 Don Hovey Dr $ 39,515.00 Demolition February 2024 City of Valparaiso, Ken Corneill (219)
465-0113
Broadway Demos $ 169,000.00 Demolition February 2024 Gary Housing Authority, Khalim
Muhammed (219) 881-6424
REFERENCES
Firm Maim@: C. Lee Construction Services Inc.
Company Name: Math aZiley
Company Address: 7500 W. 5th Ave, Gary, IN 46406
Contact NameiTitle: Brian Brown, Resource Manager
Telephone Number: 2 199 7Z722
Februa 1r�2, 20224
Email Address: B Brown@rieth-dley.com
Company Name: Walsh construction company
Company Address: 1260 E. Summitt St, Crown Point, JN 46307
Contact Namefrdie: Man; Arens, Senior Project Manawr
Telephone Number: 2 1 We-9024 Email Address: marena@wafshgroup.com
Company Name: Valparaiso University
Company Address: US Hwy 30 & Sturdy Rd, Va raiso IN 46383
Contact Namaj Tiitlee: Aleshia Peddns, Facilities Managerwrit
Telephone Number. 21 9164 -W 43
Company Name: Budd Westville
Email Address: aleshia.perkins&a o.edu
Company Address: Po Box 516, Indianapolis, IN 46206
Contact NaWitle: Brad Krueger, Superintendent
Telephone Number. 517-242-0306 Email Address. bkrueger@grangereonstrucdon.eom
Section II Plan and Equipment questionnaire
1. Work to begin upon notice to proceed and 10 day IDEM wait period. Five to seven
employees anticipated to complete the project. Work to be performed according to local
and state guidelines. Work to be completed by June 1, 2024.
2. Safe Environmental Corp of Indiana
10030 Express Drive
Highland, IN 46322
Abatement Oversight / Air Monitoring
3. Safe Environmental Corp of Indiana
10030 Express Drive
Highland, IN 46322
Abatement Oversight / Air Monitoring
4. Equipment Listing -See next page
C. LEE CONSTRUCTION SERVICES, INC.
FINANCIAL STATEMENTS
For the Nine Months Ended
September 30, 2023 and 2022
C. LEE CONSTRUCTION SERVICES, INC.
Table of Contents
Independent Accountant's Compilation Report .....................................................................................I
Financial Statements
BalanceSheets.................................................................................................................................2
Statements of Income and Retained Earnings.................................................................................3
Statementsof Cash Flows................................................................................................................4
Supplementary Information
Schedules of Cost of Contract Revenue Earned..............................................................................5
Schedules of General and Administrative Expenses.......................................................................6
D8&
Desmond &Ahern, Ltd,
CERTIFIED PUBLIC ACCOUNTANTS & CONSULTANTS
To Management
C. Lee Construction Services, Inc.
Gary, IN
Management is responsible for the accompanying financial statements of C. Lee Construction
Services, Inc. (an Indiana S Corporation), which comprise the balance sheets as of September 30,
2023 and 2022, and the related statements of operations and retained earnings for the nine months
then ended in accordance with accounting principles generally accepted in the United States of
America. We have performed a compilation engagement in accordance with Statements on
Standards for Accounting and Review Services promulgated by the Accounting and Review Services
Committee of the AICPA. We did not audit or review the financial statements nor were we required
to perform any procedures to verify the accuracy or completeness of the information provided by
management. Accordingly, we do not express an opinion, a conclusion, nor provide any form of
assurance on these financial statements.
Management has elected to omit substantially all of the disclosures required by accounting principles
generally accepted in the United States of America. If the omitted disclosures were included in the
financial statements, they might influence the user's conclusions about the Company's financial
position, results of operations, and cash flows. Accordingly, the financial statements are not
designed for those who are not informed about such matters.
Supplementary Information
The supplementary information contained in the Schedules of Cost of Contract Revenues Earned and
Schedules of General and Administrative Expenses is presented for purposes of additional analysis
and is not a required part of the basic financial statements. This information is the representation of
management. The information was subject to our compilation engagement, however, we have not
audited or reviewed the supplementary information and, accordingly, do not express an opinion, a
conclusion, nor provide any form of assurance on such supplementary information.
November 18, 2023
Chicago, IL
10827 S. WESTERN AVENUE, CHICAGO, 1L 60643 • PHONE 773-779-4720 o FAX 773-779-8310
CITY OF SOUTH BEND r `
i s
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN ;` � rF.�F
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.
***Goals should be calculated based on the Base Bid only.***
C. Lee Construction Services, Inc.
Project Number: 123-014
Project Name:
Bidder: C. L" Cov A"4^ kr Wk1d5.
a-,
Name & Address of MBE Primary Contact Person
(NamelTelephone)
SGrv-10, xr r- . 3 o o +
Demolition of 1000 West Sample Street
Base Bid Amount: l 0 zo. 0 D MBE Goal: 1.39%
Scope of Work to be Performed
(Attach scope/schedule if you need additional space)
Submitted by: 'rruLw LIB V0,
Print Name Signature
***Goals should be calculated based on the Base Bid only.***
Version 07/19/2023 Contractor's Bid for Public Works - 8
Page If of I
Dollar Amount of MBE rVI�Vlna!
Component of Total
*a514titzS.00 1 6-1/,
°,r
Date
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
-,
FORM WBE-1.0 -----A '
WBE UTILIZATION PLAN
This completed form should be supplies! 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.
***Goals should be calculated based on the Base Bid only.***
C. Lee Construction Services, Inc.
Project Number: 123-014 Project Name: Demolition of 1000 West Sample Street
Bidder: C.LQ, }ip ,iei t Base Bid Amount * l 17 q q 9 Zo o
G.
0 WBE Goal: 4.65 /o
Page I of
Name 8 Address of WBE Primary Gontact Person to be Performed Dollar Amount of WBE Percentage
(NamelTelephone) �(Al�tch,,o�pe/schofd�uleifyou need additional spaoe) Com onent of Total
p
is 11�iu..c�tCl►. C.1.>Et 1N;4� b•c Dtr•
e l 1pe a C.ur 41NIC4 , Cdt, of bush
'" 81 '/. of + v— -1!%64 cow
Submitted by: .Ir dltr1' L 41.
Print Name 5ignatu e
'Goals should be calcu4
Version 07/19/2023 Contractor's Bid for Public Works - 9
based on the Base Bid only.***
A+M uew4_R
a- 17,-24
Date
,s`o m .
CITY OF SOUTH BEND r
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.0° '•.'
uns_-•
EVIDENCE OF GOOD FAITH EFFORTS
This completed form should be included as part of the Bids documents related to City of South Bend Public
Works Projects requiring Good Faith Efforts to obtain MBE participation.
Project Number: 123-014 Date: February 12, 2024
Project Name: Demolition of 1000 West Sample Street
Bidder: C. Lee Construction Services, Inc.
Contact Person: Lila Wever Telephone: 219-840-3004
Address: 1011 S. Lake St.
City: Gary State: IN Zip: 46403
Email: lwever@cleecsi.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: http://www.in.ciov/jdoa/.
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
1 Inclusion Program Plan and the Indiana Department of Administration's certified list of
Indiana Minority and Women Business Enterprises, found on their website
_Chttp://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 07/19/2023 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
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.
-rroper aemonstration oT uooa Faitn 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.
C. Lee Construction Services, Inc. is MBE/DBE certified (certificates attached). C. Lee will perform
A7 % of the work.
Version 07/19/2023 Contractor's Bid for Public Works - 11
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLANiw
FORM WBE-2A
EVIDENCE OF GOOD FAITH EFFORTS
This completed form should be included as part of the Bids documents related to City of South Bend Public
Works Projects requiring Good Faith Efforts to obtain MWBE participation.
Project Number: 123-014 Date: 2-12-24
Project Name: Demolition of 1000 West Sample Street
Bidder: C. Lee Construction Services, Inc.
Contact Person: Lila Wever Telephone: 219-840-3004
Address: 1011 S. Lake St.
City: Gary State: IN zip: 46403
Email: lwever@cleecsi.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: http://www.in.-gov/idoa/.
GOOD FAITH EFFORTS TO OBTAIN WBE PARTICIPATION
The bidder shall initial each item below, as evidence of its good faith efforts to obtain WBE participation
in the awarded contract.
I affirm that I reviewed the City of South Bend's Minority and Women Business Enterprise
/ Inclusion Program Plan and the Indiana Department of Administration's certified list of
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 1 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.
1 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 07/19/2023 Contractor's Bid for Public Works -12
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM WBE-2.0
EVIDENCE OF GOOD FAITH EFFORTS
I affirm that I have made good faith efforts to assist interested WBEs in obtaining
necessary equipment, supplies, materials, or related assistances or services, where
appropriate.
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.
-rrvper aemonstration or 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.
C Lee Construction Services, Inc. is MBE/DBE certified (certificates attached). C. Lee will perform
1 9:7 % of the work.
Version 07/19/2023
Contractor's Bid for Public Works - 13
p Ni~'4.
L`
CITY OF SOUTH BEND l✓�
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 1
Project Number: 123-014 MBE Participation Goal 1.39%
Project Name: Demolition of 1000 West Sample Street
Bidder: C. Lee Construction Services, Inc.
By: President February 12, 2024
(Signa a (Title) (Date)
MBE RWIV C. Lee Construction Services, Inc.
Owner or Contact at MBE Firm Frederick Lee
Telephone: 219-88$-9554 Fax: 219-888-9564 Email: chip@cleecsi.com
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Demolition
RESULTS OF CONTACT WITH THE MBE FIRM:
C. Lee Construction is MBE/DBE certified. C. Lee Construction will be performing 77 % of the
work.
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 07/19/2023 Contractor's Bid for Public Works -14
CITY OF SOUTH BEND Y
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN PR;(i �y•
FORM MBE-2.1 F ��5.__-1,•
WBE CONTACTED
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects
requiring Good Faith Efforts to contact WBEs. It is the bidder's sole responsibility to verify whether any listed
woman -owned business meets the WBE qualifications. Attach additional pages if necessary.
PAGE OF
Project Number. 123-014 WBE Participation Goal 4.65%
Project Name: Demolition of 1000 West Sample Street
Bidder: C Le ction Services, Inc.
By: President February 12, 2024
(Signatur (Title) (Date)
WBE Firm
Owner or Contact at WBE Finn
Telephone: Fax: Email:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
C. Lee Construction is MBE/DBE certified (certificates attached). C. Lee will erform Sl % of
the work.
RESULTS OF CONTACT WITH THE WBE FIRM:
WBE Firm
Owner or Contact at WBE Firm
Telephone: Fax: Email:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OF CONTACT WITH THE WBE FIRM:
Version 07/19/2023 Contractor's Bid for Public Works - 15
1316 Comm-Crrr BLTDjxo
227 W. kMMSW BO MARD
-90 rm HHMC, INDIANA 46601-1830
Paonrll 5741235-9231
FAx 574/2-15-9171
TDD 5 4123.5-5367
CITY OF SOUTH BEND, JAA4F,'S MUELLER, MAYOR
BOARD OF PITRLIC WORKS
Date: Fe E, 2024
To: All Plarlholders
From Theresa Heffner, Clerk,Hoard of Public Works
Subject Addendum Number: 1
Project Name: Demolition of 1000 W. Sample 8t. (Former Fun FIX Building)
Project Number: 123.014
ACKNO VEEDGEM.ENT OF RECEHP T 0 14 D-01ENDUl _I
Datc Received. February 8 2024
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 ED.
Notes:
The attached documents are hereby added to the Specifications and Contract
Documents and become a part of herein.
company: C. Lee Construction Services, Inc.
Authorized Sigl,dum.
Date: 2-12-24
PRDJ 'T NAME: DEMOL111ON OF 1000 W. SAMpt.r ST.
ADDENDUM NO. Z
Date. February 8, 2024
To: All Plan Holders
From: Theresa Heffner, Clerk ofthe Board of public Works
Sermon 02060 — BRH&g and Site Demoftn is to be modified as follows:
1.5 Proiect Conditions
ADD item BA.- All materials resulting from building demolition ate to be treated
as hazardous. This includes the fire debris in the center of the buildings as well as
all remaining structural elements, including but not limited to the brick walls,
concrete masonry units, roofing materials, foundation walls and footings,
ADD item B.5: Contraetor shall include a full-time Indiana -licensed Asbestos
Inspector to be present on site at all times any work is being performed. There will
be no direct payment for this item. Include in the Lump Sum demolition cost.
ADD item B.6: Contractor shall include full-time Air Quality Testing to comply
with any and all applicable federal, state or local rules, laws, and regulations. Thane
will be no direct payment for this item. Include in the Lump Sum demolition cost.
— This addendum consists of a total of 2 pages —
STATE OF INDIANA DEPARTMENT OF ADMINISTRATION
Division of Supplier Diversity
Eric J. Holcomb, Governor Indiana Government Center South
402 West Washington Street, Room W462
Indianapolis, IN 46204
(317) 232 - 3061
January 12, 2024
Mr. Frederick Lee
G Lee Construction Services, Inc
1011 S. Lake Street
Gary, IN 46403
Subject: Application for MBE Certification
Dear Mr. Lee,
Congratulations! The Indiana Department of Administration, Division of Supplier Diversity is pleased to
inform you that C. Lee Construction Services, Inc. is hereby certified as a Minority Business Enterprise
(MBE).
Your company provides a commercially useful function in the areas listed below. Only work performed in
these areas will be counted towards Minority Business Enterprise participation:
UNSPSC CODE(S)
Code
Description
22101500
Earth moving machinery
30152001
Metal fencing
72103305
Drain laying service
72121406
School building construction services
72141000
Highway and road construction services
72141102
Land grading services
72141126
Under ound utilities construction service
72141205
Drainage system construction service
72141505
Earthmoving service
72141509
Trenching Services
72141510
Demolition services
72153505
Construction site clean up service
72154069
Fencing and rail service
On September 13, 2010, the Governor's Commission on Supplier Diversity approved the department's
effort to streamline its recertification process. Instead of conducting an onsite visit to each company seeking
recertification, the department now has the discretion to waive the visit after a thorough review of the
company's file and recertification documents. We have approved your recertification and it is valid through
January 31, 2027. Please note that IDOA continues to reserve the right to conduct a site visit or phone
interview at any time with certified companies.
Pagel of 2
Referencing: C. Lee Construction Services, Inc.
Although your certification is valid for three years, you are required to submit an annual Affidavit of
Continued Eligibility (ACE) form year. Instructions on how to receive and complete this form can be
located at h s://www.in. ov/idoa/mwbe/minori -and-womens-business-ente rises/certi - our -
business/. Please remember that you must notify us immediately if any changes occur. Failure to notify us
of changes or to provide an ACE form annually will result in the revocation of your certification. Changes
include, but are not limited to, changes in location, contact information, ownership, and control.
We encourage you to visit IDOA's procurement website, www.in.izov/idoa/2464,htm, and update your
Business Registration Profile. You must review and update your profile regularly, because state purchasing
agents and prime contractors may use this information to contact you for business opportunities.
While this letter serves as notification of certification, it does not serve to prove continued eligibility. Please
visit https://www.in.,Qov/idoa/mwbe/2743.htm to verify your certification status. Please contact our office
at (317) 232-3061 or mwbe@jd� oa.in ov_ if you have any other questions or concerns about your letter.
Sincerely,
P&M, ,e4rua-
Peter Sobun, Director of Certification
Indiana Department of Administration
Division of Supplier Diversity
PS/rsd
Page 2 of 2
IBD1AM BEPiDR'T FR BF TDUDPQRTATIQW
Driving ►tad►ena's Economic Growth
100 North Senate Avenue PHONE: (317) 233-4664 Eric Holcomb, Governor
Room N750 FAX: (317) 233-0891 Michael Smith, Commissioner
Indianapolis, Indiana 46204
11 /13/2023
C. Lee Construction Services, Inc.
1011 S Lake Street
Gary IN 46403
Dear Frederick B. Lee,
Subject:No Change Affidavit
This letter confirms receipt of your annual No Change Affidavit and supporting documentation .The Indiana Department of
Transportation's Equity initiative Services (EiS),in compliance with 49 CPR Parts 23 and 26, is pleased to inform you that your
firm's information has been reviewed and approved.
Your f rm's DBEIACDBE Certification will remain valid for another year.
The DBE Directory, located atINDOT: Doing Business with INDOT: DBE. Directory will continue to list your contact information
and will include the NAICS codes and description of services performed.
As a {]BEfACf]BE, you gave the fesponsibiFity to comply with all aspects of 40 CPIi Parts 23 and 2E, which include maintaining
an accurate mailing address, phone number and email addresswith INDOT EIS and promptly following up on all inquiries.
If you have any questions, please feel free to contact us atElSinauirv@indot.in,aovatany time.
Sincerely,
Derrick Casson
DBE Program Administrator, Equity Initiative Services
Indiana Department of Transportation
cc: file
NAICSIOSE Codes Assigned:
www. in. govfdall
An Equal Opportunity Employer 0
Indiana
M.,.�.
: .�MII �,al `R b•
NAM{iMF
0051.11C
Site Preparation
238910
Site Preparation
Excavation & Demolition
Contractors
Contractors
0057.50D
Brick, Stone, and
423320
Brick, Stone, and
Stone, Aggregate, Dirt, Sand,
Related Construction
Related Construction
Millings
Material Merchant
Material Merchant
Wholesalers
Who
0057.124D
Recyclable Material
423930
Recyclable Material
Crushed stone, millings, sand
Merchant Wholesalers
merchant
Wholesalers
0054.0H
Specialized Freight
484220
Specialized Freight
Dump trucking, heavy equipment
(except Used Goads)
(except Used Goods)
Trucking, Local
Trucking, Local
When tine 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:
Lake COUNTY )
The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury
that:
I. Contractor has not, nor has any other member, representative, or agent of the firm, company,
corporation or partnership represented by him, entered into any combination, collusion or agreement with
any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding
not 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:
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 07/19/2023 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 (I) 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 07/19/2023 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 12th day of February, 2024
C. Lee Construction Services, Inc.
Signature ofContrator/Bidder or Its Agent
President
Printed Name and Title
t
Subscribed and sworn to before me this 12t day of ebruary 92024
My Commission Expires 1-12-30
�, ALEry�h00,
r•�o ary Public 5aralena Pavnica
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Lake
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Version 07/19/2023 Contractor's Bid for Public Works - 6
Bid Bond
CONTRACTOR:
(Nmne, legdl sWas and ate)
Document A310 TM - 2010
Conforms with The American Institute of Architects AIA Document 310
C. Lee Construction Services, Inc.
R O. Box 618
Griffith, IN 46319
OWNER:
(Na;,M leAafalahtsdudaddrau)
City of South Bend
227 West Jefferson Boulevard
South Bend, IN 46601
SURETY:
(Nm A legalstatas and prtirclpalplaae,,f&m rmq)
The Ohio Casualty Insurance Company
175 Berkeley Street
Boston, MA 02116
Mailing Address for Notices
BOND AMOUNT: 5% Five Percent of Amount Bid
PROJECT:
(,yaw. location oradfn= mrd,l'%jeerreunrber, tf V#j
This decument has important
legal consequences. consultation
VAh an attorney Is encouraged
wigs respect to Its completion or
tnodfIcation.
Any singular reference to
Contractor, Surety, Owner or
other party shall be considered
Plural where applicable.
Demolition of 1000 W. Sample St., South Bend, IN 46619 (Former Fun FIX Building) Project No.: 123-014
The Contmetora"d Surety' are bound to the Owner in the anio►eat set forth above, for the, pa}mom of which the Cc►ntractar and Snrcty bind
Bondlbomam such
their t if
eOwne ra, admitristmtar� successors and assigns, jointly and severally. as pmvidcd herein. The conditions of this
Bond era such that if full O►vrer accepts the bid of the Contractor within the time specified in the bid documents, orwithin such time period
as may be agreed to by the Owner and Contractor, and the Contractor either (1) enters into a contract nylh the Owner in accordance with
the terms of such bid, and gives such bond or bonds astray be specified in the bidding orContract documents, with a surety admitted in
the jurisdiction of the Project and otherwise acceptable to the O►► ter, for the faithful performance of such Contract and for the prompt
pgyment of labor and tnaterrW furnished in the pmsecution thereof or (2) pays to the Onner the difference, not to exceed the amount of
this Bond, between the amount specified in said bid and such larger amount for►vhich the On -nor may in good faith contract with another
part} 10 perrorm the work- cinvred by said bid, then this obligation shall be null and void, othenvi. la remain in full fnroe and effect. The
Surety hereby uvives any notice Oran agreement het►veen the Owner and Contractor to extend the time in wn ch full A►r'ncr may accept the
bid. Wai►rot of notice by Ilia. shall not apply to any extension excceding sixty (60) days in the aggregate beyond the time for
acceptance orbids specified in tie bid documents, and the Owner and Contractor shall obtain the Surety's cunson fur an extension beyondsixty (60) days,
lfthis Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall be deemed to bo
Subcontractor and the term Owner shall be deemed to be Contractor.
When this Bond has been furnished to ccmeply with a statutory or other legal requirement in the luccetion orthe project, any provision in
this Bond r oth at' g ►vith said statutory or legal requirement shall be deemed deleted horerrnm and pro►tisions c rnfnrming la such
rtatulnty or t#b egal requirement Mod incorporated herein. When sti fumis
as a statutory ed and not as a cc an 1 bond. .the intent is that (his 13urkl strait be construed
and�talcd this 13tY j4afof February, 2024.
C. Lee Construction Services, Inc.
fPHad, ) (SedC)
►1
z6FOL�IC C tC
The Ohio Casualty Insurance Company o arNSURa
fii'tfirexc) Casy I! 11%trely) ( W11 �4Fo
By: yb
R?tlrJ William Reid' ger, Atto -in-Fact k*
S-0054/AS 8110
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�I�I�.tua�, Liberty Mutual Insurance Company
SURETY The Ohio Casualty Insurance Company
West American Insurance Carty
ROWER OF ATTORNEY
KNOWN AI L PERSONS BY THESE tfS: That The Ohio Cashraity Irhstaahce C npany is a mporabate duly wed under the laws of the State of New
mat
Inswanoe the lewd c be �e of Indiana � �ixad under M lawns of titre Slsta nil' Masamhuseib, and WW ►y wican h urancs (berry is a � d*
oiga am_R der thoh a all of t at ' of co� m owkw* Cow the mil, � b � by y teerein set foM, does l r narne, mrhsfMe and appoint
admowWp the surety bond ur eof_� tRus �d a�mey44aa wish TUNpo xaW a r* he►ebY acet%rred toar rt. anKuteand
lidncipal lame: C. Lee Construction Services Inc.
Obliges Name: Mly of South Band
tbusl�r Bored I�paAsr I
IN
t3tnhd Anmotpmt: � Bard Faun
th WITNESS relothb WHEREOF, Mils Peer f t 024
mey has 2been MkwrbBd byanaWhor¢ed of or of f of VW Cwpini s and the corporab seat of the Comm>panies thamre been affixed
Litherty Mubual Irh9r MM Comp r
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STATE OF PENNSYLVANIA ss t]mW M. Caney, Assistant gap_
COLNM OF MONTOOMERY
On tho 13th day OfFebrue 2024 : before me perMMpy appeared Ueuid M. Carey wtro � hihWVfo be the Asgieteref 5ecrei y o(Lbwiy Mtrbral
InSur as Company, The Cleo � Company, arhd AW hnwkan inSrEM Corrhphary, and that tee. as such, b ft sutim so to do, a the bego
wposes them oxmh�hed byslt dm on behalf of mg; carpal &M by hinmif es a duy MANxiaed officer. n9 khabrarmermt for the
Nit WffNM WHEW, I have thmwtu Sibmted my nh M and Mod my not" set at Pllsrhordh Meefispo fin, on day yewfirMabmwraw
�Yiarr tifeah �. ��
C mk�ioaraarbar 142eaea Teresa Pa JA, lic .
Tfltfi Power of. Per��Ylodedon of nmoarh.. af yjp� Pub
Cnnhpany, arhrt West Amertoah Hrshxanl�and Asgorhs of lire E1 Oasmyr 6Tshrarroe Corrhpery, Ldhetly I
lr�uramce Corrhpary wtddm � are rsohimr n tub face athri etTect reeving �
ARTLU N-OFFMn-, Section 12, PawerofAtfrhmey.
Any okar or other official of the CmPm8 ion authorized for lfhat purprae n wdfirg by the Clhatinan or the Pm*K and Sum to mob Tian aS me Chaiman or me
President may piwmbe, slhan appointach as May be rlmsery to ad inbei�i[of the Copmnon 4rmalok ahoschRe sal, acomoh a and denu sr surely
any aced alf borhds, rece>tnizanoee arrd otmer obli�tinrms. Such aftnigs-n-o d, shot b dB frnMWO ad " M t& reapecUiies Rowers of aftney.
*0 hove fW pchm to bind the Corpaatim by twk SOW=and axeaft cffay such instn nenb and to afth hueb to seal of the Caporaon- wbon So et AK such
instniments Pto be as �Mg a,9 dsh� by the President and allied to by the SemAny, Any poww or aui w* gra kid fo any represahtano or atlohrwy ir�fact uraler Ithe may be revoked at any nme by the Bond. the [Rail =, the pmsWdnt or by the otTrcer orotfa s grardirhg such power or �.
AR n E,E Xrd - Euecukon of Cordr�: Sed m 5. Steely Bands aand �-
Arry officer of the Cprrhpamy sulthortmd fortrat pispose in whiing by ftre dravrrhen or the pfsmd$K and b ihrwbliManorrs as ire d aimran ar the mod"tact, as may be rheosshsary io ad in beWof me Garrrpany to make, MOMS. SW, � and deliuv3r as srueiyany and anun ireappoint such .
time Y by Mi* bra any such � to et�Cfl� tfheret(� of dale n e PDWOM Of �nhefl, Shan have fun po�iVe to bind
as N signed by Me presidentard atlesled by the S�fary. Cmw#. tM so wrshtitled such iabtnne b shall be as b>irxbV
Corfikabofdeafen-ThePresidentofthe .adngpursuantbtheBYfawsofthe CMey,A tSeaeWytoappointauch abTays-
h �es�rhecasasay b ad on ballafl of the Company to mefce, exerxrb, seat, � and de nssuaety any and an mule do . bonds, reatgniz� and Iw
of A th ow =m a and of Oireclora, tha Cornpazhy conaerlb that facsimile or me lly, d y;p k*M ofany as ni Sacm
Comparhr wrlh the same bw and effect as ` of o arty t albrtey is ed by the Company it oor with mmety bohxls, shal be valid aid bihdrht upotaty
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Corm (a in PA force ad egW and has not baste ravoiwd.
IN TEST1111OW WHEREOF, I Chow bremfo set cry Mid and afbmoed time So* oFsaid Companies tile 13th day of February_, 2024
yINS
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LMIC, OC'FC WAIC . TSBR_092r723
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
RESPONSIBLE BIDDER CHECKLIST
Project Name Demolition of 1000 West Sample Street
Project No. 123-014
For Bids Due Tuesday, February 13, 2024 @ 9:00 A.M. (E.S.T.)
Contractor Name: C. Lee Construction 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 11 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 51 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 07/19/2023 General Conditions 11
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 1 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 07/19/2023 General Conditions - 12
PRE -QUALIFIED BIDDER CHECKLIST
(a) Acknowledgements:
(i) By checking this box, l hereby acknowledge th am apre-qualified bidder with
the City of South Send and that !have met the e-qualification requirements within
the last twelve (12) months. A copy of Pre -Qualification verification letter
is attached.
By checking this box, I hereby a owledge that the City reserves the right to
request supplemental inform n, additional verification of any information
provided by me, and may al conduct random inquiries of my current and prior
customers.
(b) A/ttachment
(!iana Secreta f State's on-line records (ie. Business verification) dated within
ty (60) day of the submission of said document showing that business is in
stence, rrent with the Indiana Secretary of State's Business Entity Report,
eligi for a certificate of good standing. (Not applicable to individuals, sole
pn rs or partnerships).
t ent on staffing capabilities, including labor sources. This statement
cates and ensures I have sufficient employees on staff to complete the work. It
lines how I intend to meet the staffing needs of the work.
t of projects of similar size and scope of work performed in all areas, including
State of Indiana, within the last three (3) years.
(ir every project, submit evidence of participation in apprenticeship and training
grams, applicable to the work to be performed on the project, which are
roved by and registered with the United States Department of Labor's Office of
prenticeship, or its successor organization.
Version 07/19/2023 General Conditions -13
PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED)
(a) Acknowledgements:
0) 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, 1 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:
W 2-
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) We
List identifying all former business names.
(iii) n/a
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)
(iv)
years.
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.
NO
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 07/19/2023 General Conditions - 14
(ix) nla 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: Febr 12, 2024
(Sign Here)
Frederick Lee
(Print Name Here)
C. Lee Construction Services, Inc.
(Name of Company)
1011 S. Lake St.
(Address of Company)
Gary
(City)
Indiana, 46403
(State)
(219) 888-9554
(Telephone Number)
Version 07/19/2023 General Conditions -15
BUSINESS INFORMATION
DIEGO MORALES
INDIANA SECRETARY OF STATE i
02/12/2024 05:42 PM
Business Name: C. LEE CONSTRUCTION SERVICES, Business ID: 2004110300209
INC.
Entity Type: Domestic For -Profit Corporation Business Status: Active
Creation Date: 10/27/2004 Inactive Date:
Principal Office Address: 1011 S. Lake Street, Gary, IN, 46403, USA Expiration Date: Perpetual
Jurisdiction of Formation: Indiana Business Entity Report Due 10/31/2024
Date:
Years Due:
Gowrenipg prrspn Inlarma[fan
Title Name Address
President Frederick Lee 1011 S. Lake St., Gary, IN, 46403, USA
I IAeoipBrrtrrn rurarmrline
Name Title Address
FREDERICK B LEE Incorporator 5240 ADAMS ST, GARY, IN, 46408, USA
.Xht&ml:lNrnr Ii3forinatiap
Type: Individual
Name: FREDERICK B LEE
Address: 1011 S. Lake Street, Gary, IN, 46403, USA
00010 9901 SOiy 68% IML
1011 S. Lake St.
Gary, IN 46403
219-888-9554
Fax# 219-888-9564
DBE/MBE CERTIFIED
February 12, 2024
City of South Bead
227 West Jefferson Blvd.
South Bend, IN 46601
Re: Demolition of Former FX Building, 1000 W. Sample Street
Labor Sources
Employee Classification and
Apprenticeship Participation
C. Lee Construction Services, Inc. is signatory to Local 150 Operating Engineers, Local
142 Teamster Drivers, and Local 81 Laborers Unions. We ensure that we have
sufficient employees on staff to complete the project in the allotted time frame.
We also ensure that all employees will be classified as an employee or as an
independent contractor under all applicable state and federal laws and local ordinances.
Furthermore, C. Lee Construction participates in apprenticeship training through the
labor unions to which we are signatory.
Since
Fred
Pres
(j
Authority. Chip Lee
L=�
U.S. HSE Coordinator: Eddie Oliver `==
Issuing Dept: Safety/HR Health Safety & Environment Manual p , 119 of 300
DRUG AND ALCOHOL PROGRAM
SCOPE
This policy is applicable to all C. Lee Construction Services employees and subcontractors. If subcontractors are used,
they are required to comply with this policy and testing requirements. C. Lee Construction Services will also validate
that the employees of the subcontractor have been tested to meet our client's requirements. C. Lee Construction
Services is in full compliance with DOT regs 49CFR40 and 49CFR199. As a contractor who works extensively with
natural gas and hazardous liquid pipeline operators and operators of liquefied natural gas facilities, we are required
to be in compliance with DOT regulations. C. Lee Construction Services implemented the Research and Special
Programs Administration (RSPA) Alcohol regulations as set forth in 49 CFR Part 199, B and 49 CFR Part 40, Subpart
C.
TESTING REQUIREMENTS
Drug testing is performed using a certified collector to collect the urine specimen then sent to a SAMHSA
(Substance Abuse and Mental Health Services Administration) certified laboratory for analysis. Quick screen and
dip stick tests are not acceptable.
Frequency for Testing of Drugs and Alcohol
• Pre -Employment
• Post -Accident
• Random
• Reasonable Cause
• Return to Work
4 Follow -Up as required
Drugs Being Tested For
The names of the drugs being tested for include:
• ISAM (Morphine)
• Amphetamines
• Barbiturates
• Benzodiazepines (Xanax, Valium)
• Cannabinoids (Marijuana)
• Cocaine
• MDA-Analogues (Ecstasy)
• Methamphetamines
• Methadone
• Methaqualone (Quaaludes)
■ Opiates
Phencyclidine
Propoxyphene
• Synthetics (I.E. Bath salts)
• Any other natural or artificial mind -altering substances
Revision No. 2.0 Uncontrolled copy if printed.
Initial Issue Date: 01/01/2018 Valid on day of printing only.
Revision Date: 04/15/2023 Printed on:
Next Review Date: 04/15/2024 31 January 2024 8:30 AM
Page: 119 of 300
0 C. Lee Construction Services, Inc.
Authority: Chip Lee ct
U.S. HSE Coordinator: Eddie Oliver
Issuing Dept: Safety/HR Health Safety & Environment Manual
Page: 120 of 300
Records
C. Lee Construction Services must ensure that it will maintain appropriate records for as long as we have a contract
with a client and then for 3 years after the termination of the contract. Examples include:
Chain of custody forms
Alcohol testing forms
Signed acknowledgment/consent forms
POLICY
C. Lee Construction Services has a Zero Tolerance policy towards drug or alcohol use on the job.
Any employee or subcontractor on duty or on C. Lee Construction Services property who possesses, sells, receives,
is impaired or is determined to have measurable levels of any alcohol or illegal drug in their blood or urine (no matter
the amount), post drug/alcohol screen, will be subject to immediate disciplinary action and contract dismissal.
As part of our Zero Tolerance policy, ANYviolation to the policywill result in the permanent removal of the employee
from C. Lee Construction Services or our client's premises. C. Lee Construction Services does not have a return to
duty process and will any employee or subcontractor violating this policy will be permanently banned from C. Lee
Construction Services or client property.
C. Lee Construction Services prohibits firearms, weapons, explosives, etc. when working on C. Lee Construction
Services or customer premises.
Drug and alcohol testing will be performed when there is reasonable suspicion or reasonable cause to suspect the
employee of being under the influence of a prohibited substance. The employee(s) or subcontractor(s) removed for
reasonable cause testing will not be allowed to return to work until receipt of a negative drug and alcohol test is
received.
Alcohol testing must be performed by a breath, blood or saliva (with breath confirmation) test.
Drug and alcohol testing will be performed after an accident or incident. The employees) or subcontractor
employee(s) will not be allowed to return to work on our clients' premises until documentation has been received
showing the negative drug and alcohol test.
If an employee or subcontractor returns to work following an absence of more than 90 days a return to work
screening shall occur. Follow up drug screening shall be applied when appropriate as determined by management.
C. Lee Construction Services must ensure that all employees who will be working on our client's jobsite must have
received a negative result on a drug within the past 12 months.
C. Lee Construction Services prohibits the misuse of prescription or over the counter medications. Some types of
medications could have undesirable effects, and these can create a safety risk and endanger the employee and
others. Employees must notify his/her supervisor if taking a medication that might impair their ability.
Revision No. 2.0 Uncontrolled copy if printed. Page: 120 of 300
Initial Issue Date: 01/01/2018 Valid on day of printing only.
Revision Date: 04/15/2023
Next Review Date: 04/15/2024 Printed on:
31 January 2024 8:30 AM 0 C. tee Construction Services, Inc.
Authority: Chip Lee
U.S. HSE Coordinator: Eddie Oliver
Issuing Dept: Safety/HR Health Safety & Environment Manual Page: 121 of 300
Periodically, unannounced inspections will be made of persons entering or leaving C. Lee Construction Services work
sites by authorized C. Lee Construction Services representatives. Entry onto C. Lee Construction Services or client
property is deemed to have provided consent to an inspection of a person, locker, vehicle, or any other personal
effects. Our clients have the right to conduct unannounced searches of your personnel and property and any
employee who refuses to cooperate with the searches shall be removed from our clients' property.
Any refusals to submit to a drug/alcohol screen will be treated as a positive test, resulting in immediate contract
dismissal or disciplinary action, up to and employment termination. The subcontractor or employee refusing to
submit to the test will be asked to sign a refusal document. If they refuse to sign the document, it will be noted and
kept on file.
Drug and alcohol screening will be performed by an approved and qualified medical clinic with a medical review
officer authorized to perform the tests. All results are treated with confidentiality. The switching or adulterating
any urine, blood, or any other samples is a violation of this policy.
if another subcontractor or employee comes to management with concern regarding another subcontractor or
employee in reference to alcohol or substance abuse, we will treat that with discretion and confidentiality. We will
pursue investigation and decide accordingly whether a drug and or alcohol screen is the appropriate step to take.
All subcontractors and employees are subject to the policies explained above. This policy is to be posted in all
facilities by the site supervisor.
Revision No. 2.0 Uncontrolled copy if printed.
Initial Issue Date: 01/01/2018 Valid on day of printing only.
Revision Date: 04/15/2023
Next Review Date: 04/15/2024 Printed
31 January 2024 8:30 AM
Page: 121 of 300
S L. Lee Construction Services, Inc.
Authority: Chip Lee �� A
U.S. HSE Coordinator: Eddie Oliver Co...
Issuing Dept: Safety/HR Health Safety & Environment Manual Page: 122 of 300
DRUG AND ALCOHOL SIGNATURE FORMS
DRUG AND ALCOHOL POLICY ACKNOWLEDGEMENT FORM
acknowledge that I have been provided a copy of the C. Lee Construction Services Drug and Alcohol Policy
requirements. I understand that disciplinary action, up to and including termination, will result if I violate this policy.
Employee Signature
Employee Printed Name
Date
Social Security Number (last 4 digits)
CONSENT AND AUTHORIZATION FOR DISCLOSURE TO CLIENTS OF C. LEE CONSTRUCTION
SERVICES OF ALCOHOL AND DRUG TEST RESULTS AND RELATED INFORMATION
I hereby consent to disclosure by C. Lee Construction Services and its agents, including, but not limited to, any
collecting and testing agencies, of the test results identified above and any related information to clients of C. Lee
Construction Services and its authorized agents, assigns, or representatives.
Employee Signature
Employee Printed Name
Date
Social Security Number (last 4 digits)
Revision No. 2.0 Uncontrolled copy if printed.
Initial Issue Date: 01/01/2018 Valid on day of printing only.
Revision Date: 04/15/2023
Next Review Date: 04/15/2024 Printed
31 January 2024 8:30 AM
Page: 122 of 300
0 C. Lee Construction Services, Inc.
Ass `nce
May 18, 2023
C. Lee Construction Services, Inc.
1011 S. Lake St.
Gary, 1N 46403
RE: Surety Prequalification Letter
Chicago, IL St. Louis, MO
www.assuranceagency.com
C. Lee Construction Services, Inc. is a valued client of Assurance, a Marsh & McLennan Agency LLC
company. Bonds for C. Lee Construction Services, Inc. are written through Atlantic Specialty Insurance
Company, which is rated A+ (Superior), Class XV by A.M. Best and is listed in the Federal Register.
Atlantic Specialty Insurance Company has established a surety facility for C. Lee Construction Services,
Inc. with single bond capacity of $3,000,000, and aggregate support of $10,000,000. Atlantic Specialty
Insurance Company has the utmost confidence in the management of C. Lee Construction Services, Inc.
and its financial strength to support its endeavors.
Any specific commitment to bond support would be predicated upon the company continuing to comply
with all basic underwriting standards and a satisfactory review of contract terms, bond forms and
manner of owner financing. C. Lee Construction Services, Inc. remains in good standing for continued
surety support, if requested; consideration would be given for a larger program.
Assurance, a Marsh & McLennan Agency LLC company, the agent for C. Lee Construction Services, Inc. is
located at 20 N. Martingale Rd, Schaumburg, IL 60173. Please feel free to call me at (847) 463-7251,
should you have any questions.
Sincerely,
Atlantic Specialty Insurance Company
William Reidinger
Attorney -in -Fact
State of ...Illinois.
County of.DuPage ......................ss.:
On this , I !t day of. May .. _ _ ........2023.., before me
Surety personally appeared... WiWar Reidinger
Company , , , , , , , , , , , , ,,, to be known,
Acknowledgment: whom being by me duly sworn, did depose and say: that he/she resides
at.... &bw mbvrg.L..........................................................
that he/she is the. Attorney.In Fact .......of ... Atlantic Anecialty. .. .
. .....
Insurance.C.ompany ... ....... ,, the corporation described in and which
.. ........... ...
executed the annexed instrument; that he/she knows the corporate seal of
said corporation that the seal affixed to said instrument is such corporate
seal; that it was so affixed by order of the Board of Directors of said
corporation; that he/she signed his/her name thereto by like order; and
that the liabilities of said corporation do not exceed its assets as
ascertained in the manner provided by law.
G
MtasSSM EVIRES:07i2Q3
Notary Public in and for the above County and State.
07/24/2023
My commission expires .................................
intact
INSURANCE
Power of Attornev
KNOW ALL MEN BY THESE PRESENTS, that ATLANTIC SPECIALTY INSURANCE COMPANY, a New York corporation with its principal office in Plymouth,
Minnesota, does hereby constitute and appoint: William Reldinger, Matthew V. Buol, Joseph M. Halleran, each individually if there be more than one named, its true and
lawful Attorney -in -Fact, to make, execute, seal and deliver, for and on its behalf as surety, any and all bonds, recognizances, contracts of indemnity, and all other writings
obligatory in the nature thereof; provided that no bond or undertaking executed under this authority shall exceed in amount the sum of: unlimited and the execution of such
bonds, recognizances, contracts of indemnity, and all other writings obligatory in the nature thereof in pursuance of these presents, shall be as binding upon said Company as if
they had been fully signed by an authorized officer of the Company and sealed with the Company seal. This Power of Attorney is made and executed by authority of the
following resolutions adopted by the Board of Directors of ATLANTIC SPECIALTY INSURANCE COMPANY on the twenty-fifth day of September, 2012:
Resolved: That the President, any Senior Vice President or Vice -President (each an "Authorized Officer") may execute for and in behalf of the Company any and
all bonds, recognizances, contracts of indemnity, and all other writings obligatory in the nature thereof, and affix the seal of the Company thereto; and that the
Authorized Officer may appoint and authorize an Attorney -in -Fact to execute on behalf of the Company any and all such instruments and to affix the Company
seal thereto; and that the Authorized Officer may at any time remove any such Attomey-in-Fact and revoke all power and authority given to any such Attomey-in-
Fact.
Resolved: That the Attorney -in -Fact may be given full power and authority to execute for and in the name and on behalf of the Company any and all bonds,
recognizances, contracts of indemnity, and all other writings obligatory in the nature thereof, and any such instrument executed by any such Attomey-in-Fact shall
be as binding upon the Company as if signed and sealed by an Authorized Officer and, further, the Attomey-in-Fact is hereby authorized to verify any affidavit
required to be attached to bonds, recognizances, contracts of indemnity, and all other writings obligatory in the nature thereof.
This power of attorney is signed and sealed by facsimile under the authority of the following Resolution adopted by the Board of Directors of ATLANTIC SPECIALTY
INSURANCE COMPANY on the twenty-fifth day of September, 2012:
Resolved: That the signature of an Authorized Officer, the signature of the Secretary or the Assistant Secretary, and the Company seal may be affixed by
facsimile to any power of attorney or to any certificate relating thereto appointing an Attorney -in -Fact for purposes only of executing and sealing any bond,
undertaking, recognizance or other written obligation in the nature thereof, and any such signature and seal where so used, being hereby adopted by the Company
as the original signature of such officer and the original seal of the Company, to be valid and binding upon the Company with the same force and effect as though
manually affixed.
IN WITNESS WHEREOF, ATLANTIC SPECIALTY INSURANCE COMPANY has caused these presents to be signed by an Authorized Officer and the seal of the Company
to be affixed this twenty-seventh day of April, 2020.
r\P�t "st,9
iy@G
SEALL
SEGgAFOF 9y�40
=Y 1986 01
By
STATE OF MINNESOTA�b Fla o;
Paul J. Brehm, Senior Vice President
HENNEPIN COUNTY uo
On this twenty-seventh day of April, 2020, before me personally came Paul J. Brehm, Senior Vice President of ATLANTIC SPECIALTY INSURANCE COMPANY, to me
personally known to be the individual and officer described in and who executed the preceding instrument, and he acknowledged the execution of the same, and being by me
duly swom, that he is the said officer of the Company aforesaid, and that the seal affixed to the preceding instrument is the seal of said Company and that the said seal and the
signature as such officer was duly affixed and subscribed to the said instrument by the authority and at the direction of the Company.
ALISON DWAN MASH -TROUT
NOTARY PUBLIC-MINNESOTA
My Commission Expires
January 31, 2025
, 244e
Notary Public
I, the undersigned, Secretary of ATLANTIC SPECIALTY INSURANCE COMPANY, a New York Corporation, do hereby certify that the foregoing power of attorney is in full
force and has not been revoked, and the resolutions set forth above are now in force.
Signed and sealed. Dated 18th day of May 2023
This Power of Attorney expires
January 31, 2025
�4G GgRFORkTF.9n=.
SEAL mi
=' 1986 6
4za.yFw �oPF.aa�s
Kara Barrow, Secretary
Please direct bond verifications to surety@intactinsurance.corn
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