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Opening of Bids - High Street Sidewalk Improvements Proj No. 123-012 - Premium Concrete Srvs.
sourt BF��_ CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK CHECKLIST FOR BIDDERS Project Name High Street Sidewalk Project Project No. 123-012 For Bids Due May 14, 2024 From time to time the South Bend Board of Public Works finds it necessary to reject a bid because iIt 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 Certification of use of United States Steel Products or Foundry Products. Proof of M/WBE Utilization Plans [MBE-1.0 and WBE-1.0]. Also provide Evidence of Good Faith Efforts Forms [MBE-2.0 and WBE-2.0] and M/WBE Contacted Forms [MBE-2.1 and WBE-2.1 ]. Acknowledge Receipt of � Addendum(s) included with the bid. ✓ All required additional information is included with the bid. / Proposal statements and other affidavits all signed by the proper party with name either printed or typed underneath signature. V This checklist submitted with the Bid. This checklist is provided for bidder's use in assuring compliance 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: Premium Concrete Services Inc. By Authorized Represen ative: Signature:" Print Name & Title: Austin Redding Date: 5/14/24 Version 07/19/2023 Contractor's Bid for Public Works - 1 \ ay n"AIA Document A310TM - 2010 Bid Bond CONTRACTOR: SURETY: (Name, legal status and address) (Name, legal status and principal place Premium Concrete Services, Inc. of business) Old Republic Insurance Company 712 Richmond St P. O. Box 0941 This document has important legal consequences. Consultation with Elkhart, IN 46516 Brookfield, WI 53008-0941 OWNER: an attorney is encouraged with (Name, legal status and address) respect to Its completlon or City of South Bend Board of Public Works modification. County -City Building Room 1316, 227 West Jefferson Blvd Any singular reference to South Bend, IN 46601 Contractor, Surety, Owner or BOND AMOUNT: other party shall be considered Five Percent of the Total Bid 5 % of Total Bid plural where applicable. PROJECT: (Name, location or address, and Project number, if any) High Street Sidewalk Project, Project No, 123-012 The Contractor and Surety are bound to the Owner hi the amount set forth above, for the payment of which the Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, as provided herein. The conditions of this Bond are such that if the Owner accepts the bid of the Contractor within the time specified in the bid documents, or within such time period as may be agreed to by the Owner and Contractor, and the Contractor either (1) enters into a contract with the Owner in accordance with the terms of such bid, and gives such bond or bonds as may be specified in the bidding or Contact Documents, with a surety admitted in the jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof; or (2) pays to the Owner the difference, not to exceed the amount of this Bond, between the amount specified in said bid and such larger amount for which the Owner may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. The Surety hereby waives any notice of an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for an extension beyond sixty (60) days. If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor. 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. Sign d and seal d this 8th day of May 2024 P mC c teS (Principal) (Seat) ( itness) c 11hu vL id et11, (Title) v^`°`Nso f��•' I / Old Republic Insurance Companv 'oy`•w'R.; (Surety) (Witness) ' s (Title) Jen ' r L. Kas a, Attney-in-Fact w, CAUTION: You should sign an original AIA Contract Document, on which s text appears in RED. An original assures that changes will not be obscured. Init. AIA Document A310' —2010. Copyright ©1963, 1970 and 2010 by The American Institute of Architects. All rights reserved, WARNING: This AIA® Document Is protected by U.s. Copyright Lew and International Treaties. Unauthorized reproduction or distrlbugon of this A] 0 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, 1 Purchasers are pemtiaed to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright@aia.org. osrrro * * * 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 SCHEMER, LISA M THOMAS, FAITH HUNT, PAMELA S. HIGGINBOTHAM of SOUTH BEND, IN its true and lawful Attorneys) -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 acts of said Attorneys -in -Fact, pursuant to these presents, are ratified and confirmed. This appointment is made under and by authority of the board of directors at a meeting held on December 10, 2019. This Power of Attorney is signed and 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 or any assistant secretary of the Company, be and hereby are authorized and directed to execute and deliver, to such persons as such officers of the Company may deem appropriate, Powers of Attorney In the form presented to and attached to the minutes of this meeting, authorizing such persons to execute and deliver and affix the seal of the Company to bonds, undertakings, recognizances, and suretyship obligations of all kinds, other than bail bonds, bank depository bonds, mortgage deficiency bonds, mortgage guaranty bonds, guarantees of installment paper and not guaranty bonds. The said officers may revoke any Power of Attorney previously granted to any such person. RESOLVED FURTHER that any bond, undertaking, recognizance, or suretyship obligation shall be valid and binding upon the Company (i) when signed by chairmen, president or anyvice president of the Company's surety division and attested and sealed (ifa seal be required) by any secretary or assistant secretary; or (ii) 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 ,Hg OLD REPUBLIC yJSUCE COMPANY 9\"" As sianSEAL Aaal lam sacreta y � w Vice President STATE OF WISCONSIN, COUNTY OF WAUKESHA- SS Onthis 30th dayof November 2022 personally came before me, Alan Pavlic 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. Notary Public pF My Commission Expires: September 28, 2026 CERTIFICATE (Expiration of notary's commission does not invalidate this instrument) 15 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. Wa�F� '3 SEAL S Signed and sealed at the City of Brookfield, WI this 8th day of May 2024 45-5314i• ORSC 11008)&93) "°1"OIAs scan $ect 4 y GIBSON INSURANCE AGENCY, INC. CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK Project Name High Street Sidewalk Project Project No. For Bids Due 14, 2024 PARTI (Must be completed for all bids. Please type or print) Date: 5/14/24 Bidder (Firm): Premium Concrete Services Inc. Address: 712 Richmond Street City/State/Zip: 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: �iSGli' $i/dEEi SZO�c✓/4�-K l�krt���7' the City of South Bend, Indiana, in accordance with plans and specifications prepared by: �PK and dated for the sum of (enter the Total Bid as shown on the Proposal) pe lrao /�t(nln4CO FoMsy_Fu:iRT/>�u5/lND ONZy �!%WORED'ilJSR7fr-NzuC _ ($ „V, i 39 ) (Enter sum of Total Base Bid plus Alternates shown on Proposal) Vd"445 (Numerical) The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the notice. Any addendums attached will be specifically referenced at the applicable page. If additional units of material included in the contract are needed, the cost of units must be the same as that shown in the original contract if accepted by the City of South Bend. If the bid is to be awarded on a unit basis, the itemization of the units shall be shown on a separate attachm n By (Signature) (Printed ame of Person Signing) The above bid is accepted this Subject to the following conditions: BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Gary A. Gilot, Member ACCEPTANCE day of 20 Joseph R. Molnar, Vice President rdan V. Gathers, Member Jo Murray L. Miller, Member Attest: Theresa Heffner, Clerk Version 07/19/2023 Contractor's Bid for Public Works - 2 PART II or projects of $100,000 or more —I C 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 Attach information regarding projects your organization has completed for the period of one (1) year prior to the date of the current bid. 2. Attach a listing of public works projects currently in process of construction by your organization. 3. Attach information regarding any failure to complete any work awarded to you and the location thereof. 4. Attach references from private firms for which you have performed work. SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE Attach an explanation of your plan or layout for performing proposed work. (Examples could include a narrative of when you could begin work, complete the project, number of workers, etc. and any other information which you believe would enable the City of South Bend to consider your bid.) 2. Attach a listing of the names and addresses of all subcontractors (i.e. persons or firms outside your own firm who have performed part of the work) that you have used on public works projects during the past five (5) years along with a brief description of the work done by each subcontractor. 3. If you intend to sublet any portion of the work, attach the name and address of each subcontractor, equipment to be used by the subcontractor, and whether you will require a bond. However, if you are unable to currently provide a listing, please understand a listing must be provided prior to contract approval. Until the completion of the proposed project, you are under a continuing obligation to immediately notify the City of South Bend in the event that you subsequently determine that you will use a subcontractor on the proposed project. 4. Attach a listing of equipment you have available to use for the proposed project. 5. Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing your proposal? If not, attach an explanation for the rationale used which would corroborate the prices listed. SECTION III CONTRACTOR'S FINANCIAL STATEMENT Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial statement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to the City of South Bend awarding the contract must be specific enough in detail so that said City of South Bend can make a proper determination of the bidder's capability for completing the project if awarded. Version 07/19/2023 Contractor's Bid for Public Works - 3 Premium Concrete Services, Inc. 712 Richmond Street Elkhart, IN 46516 (574)264-0196 SECTION I EXPERIENCE QUESTIONAIRE 1) PUBLIC WORKS PROJECTS COMPLETED IN PAST YEAR: CONTRACT AMOUNT COMPLETION DATE OWNER $ 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 $ 386,750.00 CURB & SIDEWALK 10/2023 CITY OF MISHAWAKA 2) PUBLIC WORKS PROJECTS IN PROGRESS: CONTRACT AMOUNT COMPLETIO N DATE OWNER $ 486,975.50 SPLASHPADS 6/2024 CITY OF SOUTH BEND $ 973,418.00 CURB & SIDEWALK 6/2024 CITY OF SOUTH BEND $ 7,394,177.00 STREETSCAPE 11/2024 CITY OF ELKHART $ 788,990,00 MULTI -USE PATH 6/2024 CITY OF ELKHART $ 638,543.00 PARK IMPROVEMENTS 9/2024 TOWN OF WINONA LAKE 3) NAVE NEVER FAILED TO COMPLETE ANY WORK THAT WAS AWARDED TO US. 4) REFERENCES: a. NISOURCE- MR. LUKE BRADLEY-1039 PENNSYLVANIA AVE SOUTH BEND, IN 46601 b. COZIER MANUFACTURING -MR. KEN MURR-402 N MAIN MIDDLEBURY. IN 46540 Premium Concrete Services, Inc. 712 Richmond Street Elkhart, IN 46516 (574) 264-0196 SECTION II PLAN AND EQUIPMENT QUESTIONAIRE 1) Project: HIGH STREET SIIDEWALI(PROJECT#123-012-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, clearing, removals, excavation, 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 man crew. HMA patching with 3-5 man crew. Top soil and sod will complete the project. Subs will be utilized on this project to complete traffic control, sod & trucking. Multiple crews may be working at the same time. 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: Skid Steers, Mini Excavators, Excavators, Compactors, Rollers, Walk - behind Saws, Cut-off Saws, Friction Screed, Dump Truck. Current plan is to used owned equipment, however depending on workload some rental equipment may be necessary. 5) Yes, Premium Concrete Services, Inc. has quotes for all materials in proposal. When the prospective Contractor is «noble to ceriify to any uj Ine stalenrenls below, it shall attach an explanation to this A/frdnvil. 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 SN D► A M A ) ) SS: COUNTY ) The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury that: I. Contractor has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding or to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or ndirectly, 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 inveshment activities in h'an. a. For put'poses of this Certification, "Iran" means the government of Iran and any agency or insttmnentality of b'an, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from time -to -time. b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor is engaged in investment activities in Iran if either: i. Contractor, its successor or its affiliate, provides goods or services of twenty million dollars ($2Q,OOQ000) or more in value in the energy sector of h'an; 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 h'an; 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 conhact with a person that the Contractor subsequently learns is an unauthorized alien. 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 Version 07/19/2023 Contractor's Bid for 0ublic Works - 4 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, orjoint venturers awarded a contract by the City of South Bend through its agencies, boards, or commissions shall not discriminate against any employee or applicant for employment in the performance of a City contract with respect to hire, tenure, terms, conditions, or privileges of contract or employment, or any matter directly or indirectly related to contracting or employment because of race, sex, religion, color, national origin, ancestry, gender expression, gender identity, sexual orientation, or due to age or disability that does not affect that person's ability to perform the work. In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials, or any combination of the foregoing including, but not limited to, public works contracts awarded under public bidding laws or other contracts in which public bids are not required by law, the City, its agencies, boards, or commissions will consider the Contractor's good faith efforts to obtain participation by those subcontractors certified by the State of Indiana as a Minority Business ("MBE") or as a Women's Business Enterprise ("WBE") as a factor in determining the lowest, responsible, responsive bidder. Contractors seeking the award of a City contract cannot be required to award a subcontract to an MWBE; however, they may not unlawfully discriminate against said MBE/WBE. On goal -eligible contracts, Contractors are required to either meet both MBE and WBE utilization goals or demonstrate that the Contractor has made good faith efforts to obtain participation from MBE and WBE subcontractors. A finding of noncompliance or a discriminatory practice shall prohibit that Contractor from being awarded a City contract for a period of one (1) year from the date of such determination, and such determination may also be grounds for terminating the contact to which the discriminatory practice or noncompliance pertains. 7. The undersigned Contractor agrees that the following nondiscrimination commitment shall be made a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its agencies, boards or commissions. Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the performance of this contract with privileges of employment, or any matter directly or indirectly related to employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation, handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of contract. 1, the undersigned bidder or agent as contractor on a public works project, understand my statutory obligations to the use of steel products or foundry products made in the United States (I.C. 5-16-8-1).1 hereby certify that I and all 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 f the price of United States made steel or foundry is unreasonable. I understand that violations hereunder may result in forfeiture of contractual payments. +xx Version 07/19/2023 Contractor's Bid for Public Works - 5 I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for public works are true and correct. �'� Dated this day of 1 ' {y� l IZY , 20�� B-D) Cotic�� S�Rd�cE ,14C. Contractor/Bidder (Firm) Agnaturef ontractor/Bidder or Its Agent MAq FAKEy Printed ame and Title Subscribed and sworn to before me this * day of ' . ` i _, 20A My Commission Expires �� a ) Qan A- m +�UJ1u'�,— (No y Public County of Residence C,,cmRr I JANEE M 7OWNER NOTARY PUBLIC SEAL ELKHART COUNTY, STATE OF INDIANA MY COMMISSION EXPIRES FEBRUARY 12, 2026 COMMISSION NO.710399 Version 07l19/2023 Contractor's Bid for Public Works - 6 BID/PROPOSAL CITY OF SOUTH BEND Project Name: High Streete Sidewalk Project Project Number: For Bids Due: 123-012 May 14, 2024 Contractor Name: PREMIUM CONCRETE SERVICES SOUTH � ra 18v Item No. Description Quantity Unit Unit Price Total Amount 2 MOBILIZATION AND DEMOBILIZATION 1.00 LS 12,200.00 12,200.00 3 CLEARING RIGHT-OF-WAY 1.00 LS 25612400 2,612.00 4 EXCAVATION, COMMON 300.00 CYS 65.00 19,500.00 5 TEMPORARY EROSION CONTROL 1.00 LS 13037400 1,037.00 6 TEMPORARY INLET PROTECTION 3.00 EACH 165.00 495.00 7 COMPACTED AGGREGATE, NO. 53 265.00 TON 78.00 20,670.00 8 HMA PATCHING, FULL DEPTH, TYPE B 130.00 TON 240.00 31,200.00 9 SIDEWALK, CONCRETE 569.00 SYS 75.00 42,675.00 10 CURB RAMP, CONCRETE 35.00 SYS 175.00 65125.00 11 CURB, REMOVE 25.00 LFT 21.00 525.00 12 CURB, CONCRETE 115.00 LFT 40.00 43600,00 13 CURB AND GUTTER, CONCRETE 11080,00 LFT 41.00 44,280.00 14 PCCP FOR APPROACHES, 6 IN, 85.00 SYS 105.00 8,925.00 15 SODDING, NURSERY AND TOPSOIL 11195,00 SYS 26.00 31,070.00 16 ADJUST STRUCTURE TO GRADE 2.00 EACH 390.00 780.00 17 FIRE HYDRANT ASSEMBLY, RELOCATE 1.00 EACH 6,510.00 6,510.00 18 MAINTAINING TRAFFIC 1.00 LS %835.00 %835.00 19 SIGN, REMOVE AND RESE REPLACE 2.00 EACH 550.00 1,100.00 BASE BID TOTAL: $ 244,139.00 Bidder (Firm): Premium Concrete Services Inc. Address: 712 Richmond Street City/State/Zip: Elkhart, Indiana 46516 Telephone Number: (574) 264-01913 By (Signatur Austin Redding (Printed Name of Person Signing) Version 07/19/2023 Contractor's Bid for Public Works - 7 ;OSOUTH &EEO 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. ***Goals should be calculated based on the Base Bid only *** Project Number: Bidder: 123-012 Project Name: High Street Sidewalk Project Premium Concrete Services Inc. Total Bid Amount: $ 244,139.00 MBE Goal: 8-46% 3.17 Page 1 of 1 Name &Address of MBE Primary Contact Person (Name/Telephone) Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of MBE Component Percentage of Total Bid/Proposal 1ST CLASS LOGISTICS LLC BERNARD COUTEE Trucking/Material Hauling Services $ 7800.00 3.19% Submitted by: Austin Redding 5/14/24 Print Name Signature Date ***Goals should be calculated based on the Base Bid only.*" Version 07/19/2023 Contractor's Bid for Public Works - 8 OSpt1iH pE,,�d, CITY OF SOUTH BEND x' MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM WBE-1.0 A s WBE UTILIZATION PLAN This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving WBE participation. It is the bidder's sole responsibility to verify whether any listed woman -owned business meets the WBE qualifications. ***Goals should be calculated based on the Base Bid only*** Project Number: Bidder: 123-012 Project Name: High Street Sidewalk Project Premium Concrete Services Inc. Total Bid Amount: $ 244,139.00 WBE Goal: -5-+&* 5.13% Page 1 off_ Name &Address of WBE Primary Contact Person (Namelrelephone) Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of WBE Component Percentage of Total Bid/Proposal SLUSSERS JOHN WILLIAMSON SODDING $ 10,133.60 0 4.15 /o State Barricading, Inc James Michalski Maintenance of Traffic $ 502.00 2.38% Submitted by: Austin Redding A"' Print Name Signature ***Goals should be calculated based on the Base Bid only *** Version 07/19/2023 Contractor's Bid for Public Works - 9 5/14/24 Date OSpVTH 866 CITY OF SOUTH BEND d; MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN ; FORMMBE-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: Project Name: Bidder: Contact Person: Address: City: Email: High Street Sidewalk Project Premium Concrete Services Inc. Austin Redding 712 Richmond Street Elkhart State: IN austin@premiumservices.group Date: 5/14/24 Telephone: 574-264-0196 Z;p: 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: htt ://wv4w.in. ov/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 htt ://wwwJn. ov/idoa . I affirm that I have made good faith efforts to select portions of the contract work to be X 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 X 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 X MBEs of contracting and subcontracting opportunities. I affirm that I advertised in general circulation and/or trade association publications X 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 X reasonably calculated to inform MBEs of subcontracting opportunities and allowed sufficient time for MBEs to participate effectively. X 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, X 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 X equipment, supplies, materials, or related assistances or services, where appropriate. X 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 07/19/2023 Contractor's Bid for Public Works - 11 ,oQsoorx es� , CITY OF SOUTH BEND d, MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM WBE-2,0 � �� �����a / ING� EVIDENCE OF GOOD FAITH EFFORTS This compleLed 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: 123-012 Project Name: High Street Sidewalk Project Bidder: Premium Concrete Services Inc. Contact Person: Address: City: Email: Austin Redding 712 Richmond Street Elkhart State: IN austin@premiumservices.group Date: 5/14/24 Telephone: 574-264-0 I Uu Z;p: 46516 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 listof certified MWBEs provided bythe 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.,g2y/Liiaoat/. 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 X 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 X performed by WBEs, including, where appropriate, breaking out contract work items into economically feasible units to facilitate WBE participation. X 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. X I affirm that I attended all pre -bid meetings scheduled by the City of South Bend to inform WBEs of contracting and subcontracting opportunities. I affirm that I advertised in general circulation and/or trade association publications X concerning subcontract opportunities and allowed WBEs reasonable time to respond to such advertisements. I affirm that I performed any and all necessary steps to provide written notices in a manner x reasonably calculated to inform WBEs of subcontracting opportunities and allowed sufficient time for WBEs to participate effectively. X 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 X 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, X 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 o4sourtr dei�.. CITY OF SOUTH BEND d; MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN x i! FORM WBE-2.0 INW' EVIDENCE OF GOOD FAITH EFFORTS I affirm that I have made good faith efforts to assist interested WBEs in obtaining X necessary equipment, supplies, materials, or related assistances or services, where X 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 07/19/2023 Contractor's Bid for Public Works - 13 ;O SOUTH �e�O CITY OF SOUTH BEND ol, MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN ,1a FORM MBE-2.1 du, 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 OF Project Number: Project Name: Bidder: /� nn By: !/K,L, High Street Sidewalk Project Premium Concrete Services Inc. Estimator MBE Firm 1ST CLASS LOGISTICS LLC MBE Participation Goal 3.17% 3 18% 5/14/24 (Date) Owner or Coniact at MBE Firm BERNARD COUTEE Telephone: (574) 993-0071 Fax: Email: 1STCLASSLOGISTICS2013@GMAIL.COM TYPE OF WORK SOLICITED FOR THIS PROJECT: TRUCKING RESULTS OF CONTACT WITH THE MBE FIRM: WILL UTILIZE 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 07/19/2023 Contractor's Bid for Public Works - 14 OE SptITN dgNO... CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN��z? FORM MBE-2.1 WBE CONTACTED This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring Good Faith Efforts to contact WBEs. It is the bidder's sole responsibility to verify whether any listed woman -owned business meets the WBE qualifications. Attach additional pages if necessary. PAGE OF Project Number: 123-012 WBE Participation Goal 5.13 % -6499/� Project Name: High Street Sidewalk Project Bidder: //// Premium Concrete Services Inc. By: HZI P�u, Estimator 5/14/24 (Signature) (Title) (Date) WBE Firm Slussers Green Thumb Inc Owner or Contact at WBE Firm JOHN WILLIAMSON Telephone: (574) 722-3102 Fax: Email: INFO@SLUSSERS.COM TYPE OF WORK SOLICITED FOR THIS PROJECT: SODDING RESULTS OF CONTACT WITH THE WBE FIRM: WILL UTILIZE IF AWARDED WBE Firm STATE BARRICADING INC Owner or Contact at WBE Firm JAMES MICHALSKI Telephone: (574) 287-2078 Fax: Email: STATEBARRICADEI@AOL.COM TYPE OF WORK SOLICITED FOR THIS PROJECT: TRAFFIC CONTROL RESULTS OF CONTACT WITH THE WBE FIRM: WILL UTILIZE IF AWARDED Version 07/19l2023 Contractor's Bid for Public Works - 15 1316 COUNTY -CITY BUILDING 227 W..IEFFERsoN BOULEVARD SOUTH BEND, INDIANA 46601-1830 PtIONE 574/ 235-9251 Fax 574/235-9171 '1'DD 574/ 235-5567 CITY OF SOUTH BEND TAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS Date: May 9, 2024 To: All Planholders From Theresa Heffner, Clerk, Board of Public Works Subject Addendum Number: 1 Project Name: High Street Sidewalk Project Project No.: 123-012 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: 5/10/24 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 MAY AFFECT YOUR BID. Notes: The attached documents are hereby added to the Specifications and Contract Documents and become a part of herein. Company: Premium Concrete Services Inc. Authorized Signature: Date: 5/13/24 CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK RESPONSIBLE BIDDER CHECKLIST Project Name High Street Sidewalk Project Project No. 123-012 For Bids Due May 14, 2024 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 31st 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 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 I of the Responsible Bidder Ordinance as though it were bidding directly to the City, except that the subcontractor shall submit the required information (including the name, address, and type of work) to the successful bidder prior to the commencement of work. 3. Failure of a subcontractor to submit the required information shall not disqualify the successful bidder from performing work on the project and shall not constitute a contractual default and/or breach by the successful bidder. However, the City may withhold all payment otherwise due for work performed by a subcontractor, until the subcontractor submits the required information and the City approves such information. 4. The disclosure of a subcontractor list ("Disclosed Subcontractor(s)") to the City by a bidder shall not create any rights in the Disclosed Subcontractor(s). Thus, a bidder may substitute another subcontractor for a Disclosed Subcontractor by giving the City, upon request, written notice of the name, address, licensing status, and type of work of the substitute subcontractor. 5. The successful bidder and all subcontractors on a public works project are required to submit certified payroll utilizing the federal form known as WH-347 or a similar form on a bi-weekly basis, submitted within 10 days after the end of each bi-weekly payroll period. Certified payrolls shall identify the job title and craft for each employee. Certified payrolls shall be submitted electronically. Please Note: Submissions deemed inadequate, incomplete, or untimely by the City may result in the automatic disqualification of the bid. The City, after review of complete and timely submissions, shall, in its sole discretion, after taking into account all information in the submission requirements, determine whether a bidder is responsive and responsible, and provide a Pre -Qualification Verification Letter. The City specifically reserves the right to utilize all information provided in the contractor's submission and any information obtained by the City through its own independent verification of the information provided by the contractor. Version 07/19/2023 General Conditions - 12 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. 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) Attachm nts: (i) Indiana Secretary of State's on-line records (ie. Business verification) dated within sixty (60) days of the submission of said document showing that business is in existence, current with the Indiana Secretary of State's Business Entity Report, and eligible for a certificate of good standing. (Not applicable to individuals, sole proprietors or partnerships). (I) iC 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 07/19/2023 General Conditions - 13 11. PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED) (a) Acknowledgements: (i) _ By checking this box, I hereby acknowledge that I am not a pre -qualified bidder with the City of South Bend. (ii) _ By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided, and may also conduct random inquiries of my current and prior customers. The City reserved the right to utilize all information provided in this submission and all information obtained in inquiries or requests to determine if a bidder is responsive and responsible. Additionally, I acknowledge that all information provided to the City shall be regarded as public records. (III) _ By checking this box, I hereby acknowledge that copies of all Applicable apprenticeship certificates or standards for training programs applicable to the work performed on the project may be requested at any time and shall be furnished upon request. (iv) _ By checking this box, I hereby acknowledge and ensure that I and all sub- contractors, from whom I have accepted a bid and/or intend to hire to perform work on the public work project, are properly licensed. Furthermore, I acknowledge my understanding that it is my responsibility to ensure that all sub -contractors have the necessary licenses to undertake the work called for in this bid. If a sub- contractor loses their license at any point, it is the responsibility of that sub- contractor to notify the City. (b) Attachments: (i) _ Indiana Secretary of State's on-line records (ie. Business verification) dated within sixty (60) days of the submission of said document showing that business is in existence, current with the Indiana Secretary of State's Business Entity Report, and eligible for a certificate of good standing. (Not applicable to individuals, sole proprietors or partnerships). (ii) _ List identifying all former business names. (III) _ Any determinations by a court or governmental agency any violations of federal state, or local laws including, but not limited to, violations of contracting or antitrust laws, tax or licensing laws, environmental laws, Occupational Safety and Health Act (OSHA), or federal Davis -Bacon and related Acts, within the preceding five (5) years. (iv) _ Statement about staffing capabilities, including labor sources. This statement indicates and ensures I have sufficient employees on staff to complete the work I am bidding on OR outlines how I intend to meet the staffing needs of the work. (v) _ Statement that individuals who will perform work on the public work project on my behalf will be properly classified as an employee or as an independent contractor under all applicable state and federal laws and local ordinances. (vi) _ For every project, submit evidence of participation in apprenticeship and training programs, applicable to the work to be performed on the project, which are approved by and registered with the United States Department of Labor's Office of Apprenticeship, or its successor organization. (vii) _ Copy of a written plan for employee drug testing that covers all of my employees who will perform work on the public work project and meets or exceeds the requirements set forth in IC 4-13-18-5 or IC 4-13-18-6, (viii) _ Evidence that I am utilizing a surety company which is on the Bureau of Fiscal Service "Department of Treasury's Listing of Approved Sureties' as required in the bid specifications or contract. Version 07/19/2023 General Conditions - 14 (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: 5/14/24 �� a, (Sign Here) Austin Redding (Print Name Here) Premium Concrete Services Inc. (Name of Company) 712 Richmond Street (Address of Company) Elkhart (City) IN (State) 574-264-0196 (Telephone Number) Version 07/19/2023 General Conditions -15 CITY OF SOUTH BEND DAMES MUELLER, MAYOR DEPARTMENT OF PUBLIC WORKS ERIC HORVATH, DIRECTOR May 30, 2023 Rob Becker Premium Concrete Services rbecker@premiumconcretconline.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 $150,000 submitted to the City of South Bend Board of Public Works, along with your Pre -Qualified Bidder Checklist and attachments. If you have any further questions regarding this matter, please call this office at (574) 235- 9251. Sincerely, 4 lam Theresa Heffner Board of Public Works, Clet•k 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 2 page document consisting of the following records filed in this office: Certification Date: September 12, 2023 " Business Name PREMIUM CONCRETE SERVICES, INC, Business ID: 2004120100105_ Transaction Business Date Fded �_ No. of pages 09/06/2022 1 2 Total No. of pages 2 n Witness Whereof, I have caused to be affixed my signature and the seal of the State of Indiana, at the City;of Indianapolis, September 12, 2023 DIEGO MORALES SECRETARY OF STATE 2004120100105 / 16010784 All certificates should be validated here: https://bsd.sos.in.gov/ValidateCertificate Expires on October 12, 2023, Page 1 Of3 CertificatelD:l60L0784 APPROVED AND FILED HOLLI SULLIVAN INDIANA SECRETARY OF STATE 09/06/2022 02:25 PM BI151NGSS ID 2004120100105 BUSIN ESS'TYPR Domestic For -Profit Corporation BUSINESS NAME PREMIUM CONCRETE SERVICES, INC. ENTITY CREATION DATE 11/24/2004 JURISDICTION OF FORMATION Indiana PRINCIPAL OFFICE ADDRESS 712 RICHMOND ST, ELKHART, IN, 46516, USA YEARS 202272023 EFFECTI V G DATE 09/06/2022 EFFECTIVE TIME 2:25 PM REGISTERED AGENT'CYYE Individual NAME MAX A. YEAKEY ADDRESS 712 Richmond Street, Elldtart, IN, 46516, USA TITLE President NAME f3eclry L. Yeakey ADDRESS 712 Richmond Street, Elkhart, IN, 46516, USA 'TITLE Vice President NAME Max A. Yeakey ADDRESS 712 Richmond Strcel, Elkhart, IN, 46516, USA Pnge 2 OP3 CertificatelD:16010784 Page t of 2 - APPROVED AND PILED HOLLI SULLIVAN INDIANA SECRETARY OF STATE 09/06/2022 02:25 PM IN WITNESS WHI:I2 LOF,'FHE UNDHI2SIONFD HEREBY Vf,RIFI ES,SOBJECT TO THP, PENALTI F,S OF PF,RJURY, THAT THF. STATEMENTS CONTAINED HEREIN ARE TRUE, THIS DAY September 6, 2022. THE UNDERSIGNED ACKNOWLEDGES THAT A PERSON COMMITS A CLASS A MISDEMEANOR BY SIGNING A DOCUMENT THAT THE PERSON KNOWS IS FALSE IN A MATERIAL RESPECT WITH THE INTENT THAT TILE DOCUMENT BE DELIVERED TO THE SECRETARY OF STATE FOR FILING. SIGNA'CURG /s/ Matthew A. Yeakey TITLE Legal Repiesentative Business (D : 2004120100105 Filing No.: 9549531 Page 3 Of 3 Certificate[D:16010784 -Page2of2- ftiO4"a jz1'T`.tF0iif'1 Certificate of Assumed Business Name of 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 Page 4 Of 5 CertificatelD:15712440 APPROVED AND FILED HOLLI SULLIVAN INDIANA SECRETARY OF STATE 10/12/2022 08:45 AM "::. v,� "� `. u ,. ,,,; C�I2�'ZFICA;T'COP;ASSUMEA�73t7$JN>aSSNAA4C ., IVAINErA"NTp IVAINErA"NTp PR[fGIPAL OI+RiCI; Al?T1I2F,,SS ;" ."' BUSINESS ID 2004I20100105 BUSINESS TYPE Domestic For -Profit Corporation BUSINESS NAME PREMIUM CONCRETE SERVICES, INC. PRINCIPAL OFFICE ADDRESS 712 RICHMOND ST, ELKHART, IN, 465163 USA I?FFEC'FIVE DATC EFFECTIVE TIME 10/I I/2022 04:58PM Premium Services 712 Richmond Street, Elkhart, IN, 46516, USA IN WITNESS WHEREOF, THE UNDERSIGNED HEREBY VERIFIES, SURIECT TO THE PENALTIES OF PERJURY, THAT THE STATEMENTS CONTAINED HEREIN ARE TRUE, THIS DAY October I1, 2022. THE UNDERSIGNED ACKNOWLEDGES THAT A PERSON COMMITS A CLASS A MISDEMEANOR BY SIGNING A DOCUMENT THAT THE PERSON KNOWS IS FALSE IN A MATERIAL RESPECT WITH TI-IE INTENT THAT THE DOCUMENT BE DELIVERED TO THE SECRETARY OF STATE FOR FILING. SIGNATURE TITLE Saulo I. Delgado Legal Representative Business ID : 2004120100105 Filing No.: 9591 S94 Faoc 5 Of 5 CertificatelD:157 L2440 - Page J of 1 - 75 2 - 2 2 0 0 n F F ^ F tl F _ F F v 7 7 7 72 2 7 7 7 2 7 7 - ? F - _ °' Er 3 R-39514 LaSalle & M4rquette South Bend INDOT $ 210,779.59 Sidewalk, ADA compliant 1902 7-40046-ATraffic 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 milk 1936 R-40913 Howe, IN SR 12 Howe IIVDOT $ 57,989,85 Concrete Asubstructure,Cuncrete Bfoolhigs, reinforcing bars epoxy coated. 1929 Cityuf Elkhart Various Elkk"on City of Elkhart $ 70,171.85 Various concrete curb, sidewaRk&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 Ser 'ces, 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 AM FAX 8122795545 ILTI FAX INDIANA LABORERS' TRAINING TRUNT.FUND 0002/0008 David A. Frye Secretary-Treaxttrer lerry J. Bolk Chris Brickey Ricky Henson, Jr, Raman Mendoza, ,Ir, Brian Short P.O. Box 758 - Badford, Yndlana 47421 (912)279-9751 May 23, 2029 To Whom It May Concern: Sean L'nnkley, Director Jnlra P. Brown Chairtnau Kelly Abel Michael !Ferrara Stun Afeyer Nick Timmerman Iim Wiseman FAX: (8I2) 279-5545 Toll Free (900) 742-4086 This letter is to confirm that "Yremiunt Concrete Services, inc." is a signatory contractor in good standing with the Indiana Laborers' Training Trust Fund. 'The 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. Further, our organization's program is approved by the U.S. Veterans Administration to participate in the CrI 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 t 6 Sean Coakley, Director St::ap www. indiunulnborerslrctining.nr•� 05/23/2025 11:10 AM FAX 8122795545 ILTI FAX la0008/0008 o� 05/23/2023 11:16 AM FAX 8122795545 ILTI FAX 0004/0008 STATE F INDIANA DEPARTMENT OF VETERANS AFFAIRS STATE APPROVING AGENCY 402 WEST WASHINGTON STREET ROOM W-460 INDIANAPOLIS, INDIANA 46204.2788 Jeremy 13rcwer Apprenticeship Coordinator Indiana Laborers Training Trust Fund -Apprenticeship 439 Patton Hill Rd, Bedford, IN 47421 Dear Jeremy 13rcwer, Eric Holcomb, Governor James M. Brown, Director January 9, 2019 The Indiana State Approving Agency cozlductcd a supervisory visit on Ol!$/2019 at Indiana Laborers Training Trust. FunckApprenticeship. The purpose of the visit was to provide training to the Certifying OI}icials and review enrollment certifications, record retention and reporting procedures. The organisation demonstrated proper record maintenance and record znahntenarzce 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 the Certifying Officials via VA Form 22-8794, work processes, and wage scale. If you need any assistance or have any questions regarding this teclulical visit please contact me directly at tgrufnr(d dvaan.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, Taniqua Griffin Program,I7irector Yhonn(317)•234-6062 Toll;+'ree(800)•400.45?0 Fax (317)-234•R744 05/23/2023 11:16 AM FAX 8122795545 ILTI FAX U 0005/0008 STATE OF II NA DEPARTMENT OF VETERANS AFFAIRS STATE APPROVING AGENCY 402 WEST WASHINGTON STREET ROOM W469 INDIANAPOLIS, INDIANA 45204-2738 Jeremy Brewer Apprenticeship Coordinator Indiana Laborers Training Trust Fund -Apprenticeship 439 Patton Hill Rd, Bedford, IN 47421 Dear Jeremy Brewer, Eric Holcomb, Oovernol James M. Brown, Director 7anuary 9, 2019 This wi11 acknowledge receipt of your updated 'Wage Scale for the Construetion� Craft Taborer pragrauxz offered by Indiana Laborers Training Trust Frmd-Apprenticeship. The State Approving Agency has reviewed the document as listed below: Wage Scale: Construction Craft Laborer FACTT.1'! Y CODF: 30004114 To the best ot'my harowlcdge Indiana Laborers Training Trust Fund -Apprenticeship does not utilize erroneous or misleading advezfisement, either by actual statement, omission, orintimation, It is understood by Indiana Laborers Training Trust Fund -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 months. Indiana Laborers Training Trust Fund-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 for contezzt and accuracy. Approval is grantod puxsuarrt to the previsions of Title 38, tJ.S. Cade 3687, with an e.Pfective date of Apri11, 2018. If you have any questions, please feel tree to give me a call at 317-232-3916 or email me at tgriffm@dva.in,gov. Thank you Por what. you do for our Veterans, and have a great day! Sincerely, '1'aniqua Griffin Program Director State Approving Agency Cc: VARO/KT.R. �gpnRo�Nc f�fy._ 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, INDIANA46204-2738 Jeremy Brewer Apprenticeship Coordinator Indiana Laborers Training Trust Ftn1d-Apprenticeship 439 Patton IIill Rd. Bedford, IN 47421 Dear Jeremy I3rewcr, Eric Holcomh, Governor James M. Brown, Director January 9, 2019 This will aclmowledgc receipt oPyour revised Work 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: TI7AINING FROGRAM LENGTI� DOT CODE Construction Craft Laborer FACILITX CODE: 30004174 4,000-7800 hours 47�2061.00 To xhe best of my lmowledge Indiana Laborers Training Trust Ftuid-Apprenticeship does nit utilize erroneous or misleading advertisement, either by actual statement, omission, or intimation. It is understood by Indiana Laborers Training Trust Fund -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. The company's advertising will be available for review by any and all future supervisory visits by the SAA, or the U.S. Department of Veteran Affairs, This approval is made puxsutult to and under the provisions ofTitle 38, U. S. Code 3487, with an effective date of Jaunary 8, 20I9• If you have any questions, please contact me at 317-232�391.6. Sincerely, M► • Talriqua Griffin Progrant Director State Approving Agency CC:VARO/F.J.R J9ti TO 46 4>A 9r'/Jy %D� tQ PUono(317)-234-60t2 'rollFrce(800)-400-4520 P'ax(377)-239-8744 05/23/2023 11:17 AM FAX 8122795545 ILTI FAX �10007/0008 Apprentice Status Report By Indenture Date Apprentices Indentured Between 111/2078 And 713/2022 Apprentice Program: IN2 Year Apprentice Status Apprentices Percentage 2418v IF 2019 AE<iVe. 68 8 Ob:% Active Duty 2 04240/0 Adv,'4o 3oume=yman Deceased OFF 5 0.59 % Graduated IF IF I F.d .71.IF: ,... s 4q*b Inactive 101 1,18 % 7ourne>..ytnan'.: ".... ..OF 2 . ..,.0:24Its Med. Susp, i 0.12 Reinstate OF Suspended 7 0483 % rerminatea. ,.OF 546 ' 64.62 °/a Voluntary withdraw 38 4,50 %e TotalIndentured 845 Adv. to Journeyman 72 7,70 0� i7eceegedIF I 8 ,IF Graduated 51 5,45 e/ ,. 1.18 GH Journeyman 12 118 % 61ed::Susp IF 2 Reinstate 15 1,60 % Susohded 11,32 °!d Terminated $28 56,97 % doluntary withdraw I 1 1 68 7.27 */n Total Indentured 935 rioted: Wednesday, July t3, 2022 Page i of 2 05/23/2023 11:17 AM FAX 8122795545 ILTI FAX �10008/0008 Apprentice Status Report By Indenture Date Apprentices Indentured Between 1/1/2018 And 7/13/2022 Apprentice Program: IN2 Year Apprentice Status Apprentices Percentage 2020 2027 2022 Active :: ..:: '', . ; 242::.: 36:28:°!0 Adv, to Journeyman 33 4995 0/0 Receasetl 2 .: O':304Lo Graduated 3 0.45 % Journeyman... .. 1 U:15 %... ... .. Med. Suspe 4 u 0160 /o 0,15% Reinstate 1 121 1.80 Suspended 9 0 45 % Terminated 329 49 33 % valuritary withdraw 37 5 SS Total Indentured 667 Active Duty 1 0,13 % Ady; to Journeyman 23 Deceased 2 0.26 % Med. Susp;......... 3 . 0.39 % Reinstate 20 2.58 % ded Suspen`;; . Z; 0 26:°(a Terminated 220 28,39 vviuntary'witBdrap ` . 32 :,.;.. 4.�$ No Totalindentured 775 Adv, to Journeyman 4 0,65 /o 0116% Med. Susp. 2 0,32 % Not Registered 5' . 0,81 P(°. Reinstate 331 5,32 % Terminated. ', 32 5.16 % Voluntary withdraw 51 0,81 % Total Indentured 620 Printed: Wednesday, July 13, 2022 Page 2 p/ 2 Plasterers & Cement Masons' Apprenticeship Coordinator Local Union #692 To Whom it May Concern: ANpC�H 4 s 6. O O � y 1864 - 'j'0HAt KSS�4e Phone:(219)707-7767 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 maybe 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 e~�QERS ANoc� a � o I86 - /0 AL ASsoc. Year 15Y 2nd 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:(219)707-7767 Email: bkristoff@plcmlocal692,org 9200 Louisiana Street Merrillville, Indiana 46410 WWW.PLCMLOCAL692.ORG • r PREMIUM CONCRETE SERVICES, INC. Elkhart, Indiana DECEMBER 31, 2022 TABLE OF CONTENTS INDEPENDENT ACCOUNTANTS' REVIEW REPORT . FINANCIAL STATEMENTS Balance Sheets.............................4......................... Statements of Income and Retained Earnings I.......4 Statements of Cash Flows ....................................... Notes to the Financial Statements ........4.................4 SUPPLEMENTARY INFORMATION Schedule I — Direct and Indirect Contract Costs ...... Schedule II — General and Administrative Expenses Page Number ........ 1 DORNE ... :. C P A S R 0 U P I_ 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 income 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. Cornerstone CPA Group LLP 2 37.G0 Windsor Court ro E:II<hart, IN 46514 n Phone 574-?62-8856 or 574-296-J36Q 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 nformation and do not express an opinion on such information. CORNERSTONE CPA GROUP, LLP Certified Public Accountants Elkhart, Indiana June 26, 2023 c2)