HomeMy WebLinkAboutOpening of Bids - SB - SBCSC Administration Building Renovation - Elevator Replacement Proj No. 124-001A - Gibson-LewisCITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
Project Name
Project No.
For Bids Due
South Bend - SBCSC Administration Building - Elevator Replacement
124-001 A
28 May 2024
PART I
(Must be completed for all bids. Please type or print)
Date: 5/28/24
Address: 1001 W. llth Street
Bidder (Firm): Gibson -Lewis, LLC
City/State/Zip: Mishawaka, IN 46544 Telephone Number: 574 259-8581
Email Address: ngurbick(a,gl.nceusa.com
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:
SBCSC Administration Buildina Renovation - Elevator Replacement Proiect 4124-OO1.A
the City of South Bend, Indiana, in accordance with plans and specifications prepared by:
American Strcturepoint, Inc. 9025 River Road, STE 200, Indianapolis, IN 46240
and dated 4/15/2024 for the sum of (enter the Total Bid as shown on the Proposal)
(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 contra arroa
ea t cost of units must be the same as that
shown in the original contract if accepted by the sty th nd. If the bid is to be awarded on a unit
basis, the itemization of the units shall be show n Fa ttachment.
By
The above bid is accepted this
Subject to the following conditions:
Nick Gurbiick, lice President@)
(Printed Name of Person Signing)
ACCEPTANCE
day of
BOARD OF PUBLIC WORKS
President
Members
Version 03/15/2024 Contractor's Bid for Public Works - 2
20
Bidder: Gibson -Lewis, LLC
PART II
(For projects of $100,000 or more — IC 36-1-12-4)
These statements to be submitted under oath by each bidder with and as part of his/her/its bid.
Attach additional pages for each section as needed.
SECTION I EXPERIENCE QUESTIONNAIRE
1. Attach information regarding projects your organization has completed for the period of one
(1) year prior to the date of the current bid.
2. Attach a listing of public works projects currently in process of construction by your
organization.
3. Attach information regarding any failure to complete any work awarded to you and the
location thereof.
4. Attach references from private firms for which you have performed work.
SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE
1. Attach an explanation of your plan or layout for performing proposed work. (Examples could
include a narrative of when you could begin work, complete the project, number of workers,
etc. and any other information which you believe would enable the City of South Bend to
consider your bid.)
2. Attach a listing of the names and addresses of all subcontractors (i.e. persons or firms outside
your own firm who have performed part of the work) that you have used on public works
projects during the past five (5) years along with a brief description of the work done by each
subcontractor.
3. If you intend to sublet any portion of the work, attach the name and address of each
subcontractor, equipment to be used by the subcontractor, and whether you will require a
bond. However, if you are unable to currently provide a listing, please understand a listing
must be provided prior to contract approval. Until the completion of the proposed project, you
are under a continuing obligation to immediately notify the City of South Bend in the event that
you subsequently determine that you will use a subcontractor on the proposed project.
4. Attach a listing of equipment you have available to use for the proposed project.
5. Have you entered into contracts or received offers for all materials which substantiate the
prices used in preparing your proposal? If not, attach an explanation for the rationale used
which would corroborate the prices listed.
SECTION III CONTRACTOR'S FINANCIAL STATEMENT
Attachment of bidder's financial statement is mandatory. Any bid submitted without said
financial statement as required by statute shall thereby be rendered invalid. The financial
statement provided hereunder to the City of South Bend awarding the contract must be specific
enough in detail so that said City of South Bend can make a proper determination of the bidder's
capability for completing the project if awarded.
*Please see attached Financial Statement
Version 03/15/2024 Contractor's Bid for Public Works - 3
ACCEPTANCE
The above bid is accepted this day of subject to the
following conditions:
Contracting Authority Members:
PART II
(For projects of $150,000 or more — IC 36-1-12-4)
Governmental Unit: City of South Bend, Indiana Board of Public Works
Bidder (Firm) Gibson -Lewis, LLC
Date (month, day, year): 5/28/24
These statements to be submitted under oath by each bidder with and as a part of his bid.
Attach additional pages for each section as needed.
SECTION I EXPERIENCE QUESTIONNAIRE
1. What public works projects has your organization completed for the period of one (1) year prior to the
date of the current bid?
Contract Amount
Class of Work
Completion
Date
Name and Address of Owner
4,749,000.00
2023
Hanover ES - Cedar Lake, IN
6,470,100.00
2023
Northridge HS & Athletic Add - Middlebury, IN
4,598,900.00
2023
Monger ES - Elkhart, IN
1,044,640.00
2023
Homestead HS - Fort Wayne, IN
2. What public works projects are now in process of construction by your organization?
Contract Amount
Class of Work
Expected
Completion
Date
Name and Address of Owner
3,997,000.00
2024
Crown Point MS - Crown Point, IN
1,616,000,00
2024
Lake Prairie ES - Lowell, IN
7,936,000.00
2024
Tippecanoe Valley HS - Tippecanoe, IN
2,541,500.00
2024
PHS Performing Arts - Mishawaka, IN
Bidder: Gibson -Lewis, LLC
3. Have you ever failed to complete any work awarded to you? No If so, where and why?
4. List references from private firms for which you have performed work.
University of Notre Dame - Notre Dame, Indiana
Memorial Hospital of South Bend - South Bend, Indiana
1st Source Bank
- South Bend, Indiana
SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE
1. Explain your plan or layout for performing proposed work. (Examples could include a narrative of when
you could begin work, complete the project, number of workers, etc. and any other information which you
believe would enable the governmental unit to consider your bid.)
2. Please list the names and addresses of all subcontractors (i.e. persons or firms outside your own firm
who have performed part of the work) that you have used on public works projects during the past five (5)
years along with a brief description of the work done by each subcontractor.
Please see attached listing
SELECTED SUBS FOR FORM 96
INDIANA EARTH
EXCAVATING
RITSCHARD BROS., INC.
10343 MCKINLEY HWY
1204 W SAMPLE STREET
OSCEOLA, IN 46561
SOUTH BEND, IN 46619
WALSH & KELLY
PAVING
RIETH RILEY CONSTRUCTION
24358 STATE ROAD 23
25200 STATE ROAD 23
SOUTH BEND, IN 46614
SOUTH BEND, IN 46614
ZIOLKOWSKI CONSTRUCTION
MASONRY
KWIATKOWSKI MASONRY
1005 S LAFAYETTE STREET
1006 N INDIANA AVENUE
SOUTH BEND, IN 46601
CROWN POINT, IN 46307
STEVENS IRON WORKS, INC
STRUCTURAL STEEL
CRANE INDUSTRIAL SERVICES
P.O. BOX 730
11035 ANDERSON ROAD
DEMOTTE, IN 46310
GRANGER, IN 46530
MIDLAND ENGINEERING
ROOFING
DUDECK ROOFING & SHEET METAL
52369 STATE HWY 933
1634 SOUTH FRANKLIN STREET
SOUTH BEND, IN 46637
SOUTH BEND, IN 46614
WERNTZ SUPPLY
GLASS & GLAZING
PRECISION WALL
1002 KERR STREET
3801 S MAIN STREET
SOUTH BEND, IN 46601
SOUTH BEND, IN 46614
OVERHEAD DOOR COMPANY
OVERHEAD DOOR
INDUSTRIAL DOOR OF NORTHERN IN
P.O. BOX 907
3839 S. MAIN STREET
MISHAWAKA, IN 46546
SOUTH BEND, IN 46614
MIDWEST TILE & INTERIORS INC
FLOORING
INTERIOR FINISHES, INC.
1805 N CEDAR ST
1616 W THIRD STREET
MISHAWAKA, IN 46545
OSCEOLA, IN 46561
SHAMBAUGH & SON
FIRE PROTECTION
RYAN FIRE PROTECTION
7614 OPPORTUNITY DR
9740 EAST 148TH STREET
FORT WAYNE, IN 46825
NOBLESVILLE, IN 46060
DA DODD, INC
PLUMBING & HVAC
EDWARD J WHITE
P.O. BOX 430
1011 S. MICHIGAN STREET
ROLLING PRAIRIE, IN 46371
SOUTH BEND, IN 46601
MARTELL ELECTRIC
ELECTRIC
KOONTZ WAGNER SERVICES
4601 CLEVELAND ROAD
3801 VOORDE DR SUITE B
SOUTH BEND, IN 46628
SOUTH BEND, IN 46628
Bidder: Gibson -Lewis, LLC
3.
If you intend to sublet any portion of the work, state the name and address of each subcontractor,
equipment to be used by the subcontractor, and whether you will require a bond. However, if you are
unable to currently provide a listing, please understand a listing must be provided prior to contract
approval. Until the completion of the proposed project, you are under a continuing obligation to
immediately notify the governmental unit in the event that you subsequently determine that you will use a
subcontractor on the proposed project.
Unresolved
4. What equipment do you have available to use for the proposed project? Any equipment to be used by
subcontractors may also be required to be listed by the governmental unit.
All necessary
5. Have you entered into contracts or received offers for all materials which substantiate the prices used in
preparing your proposal? If not, please explain the rationale used which would corroborate the prices
listed.
No
SECTION III CONTRACTOR'S FINANCIAL STATEMENT
Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial
statement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to
the governing body awarding the contract must be specific enough in detail so that said governing body can make
a proper determination of the bidder's capability for completing the project if awarded.
When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit.
CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION
REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON-
DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL
PRODUCTS OR FOUNDRY PRODUCTS
(Must be completed for all quotes and bids. Please type or print)
STATE OF INDIANA )
) SS:
STJOSEPH COUNTY )
The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury
that:
1. Contractor has not, nor has any other member, representative, or agent of the firm, company,
corporation or partnership represented by him, entered into any combination, collusion or agreement with
any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding
nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and
without any agreement, understanding or combination with any other person in reference to such bidding.
Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or
indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and
2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals
are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
participation in this transaction by any Federal department or agency; and
3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in
investment activities in Iran.
a. For purposes of this Certification, "Iran" means the government of Iran and any agency
or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as
amended from time -to -time.
b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor
is engaged in investment activities in Iran if either:
i. Contractor, its successor or its affiliate, provides goods or services of twenty
million dollars ($20,000,000) or more in value in the energy sector of Iran;
or
ii. Contractor, its successor or its affiliate, is a financial institution that extends
twenty million dollars ($20,000,000) or more in credit to another person for
forty-five (45) days or more, if that person will (i) use the credit to provides
goods and services in the energy sector in Iran; and (ii) at the time the
financial institution extends credit, is a person identified on list published by
the Indiana Department of Administration.
4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any
employee or contract with a person that the Contractor subsequently learns is an unauthorized alien.
Version 03/15/2024 Contractor's Bid for Public Works - 4
Bidder: Gibson -Lewis, LLC
Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of Contractor's
newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3. Contractor's
documentation of enrollment and participation in the E-Verify Program is included and attached as part of
this bid/quote; and
5. Contractor shall require his/her/its subcontractors performing work under this public contract to
certify that the subcontractors do not knowingly employ or contract with an unauthorized alien, nor retain
any employee or contract with a person that the subcontractor subsequently learns is an unauthorized alien,
and that the subcontractor has enrolled in and is participating in the E-Verify Program. The Contractor agrees
to maintain this certification throughout the term of the contract with the City of South Bend, and understands
that the City may terminate the contract for default if the Contractor fails to cure a breach of this provision
no later than thirty (30) days after being notified by the City.
6. Persons, firms, partnerships, corporations, associations, or joint venturers awarded a contract by the
City of South Bend through its agencies, boards, or commissions shall not discriminate against any employee
or applicant for employment in the performance of a City contract with respect to hire, tenure, terms,
conditions, or privileges of contract or employment, or any matter directly or indirectly related to contracting
or employment because of race, sex, religion, color, national origin, ancestry, gender expression, gender
identity, sexual orientation, or due to age or disability that does not affect that person's ability to perform the
work.
In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials, or any
combination of the foregoing including, but not limited to, public works contracts awarded under public
bidding laws or other contracts in which public bids are not required by law, the City, its agencies, boards,
or commissions will consider the Contractor's good faith efforts to obtain participation by those
subcontractors certified by the State of Indiana as a Minority Business ("MBE") or as a Women's Business
Enterprise ("WBE") as a factor in determining the lowest, responsible, responsive bidder.
Contractors seeking the award of a City contract cannot be required to award a subcontract to an MWBE;
however, they may not unlawfully discriminate against said MBE/WBE. On goal -eligible contracts,
Contractors are required to either meet both MBE and WBE utilization goals or demonstrate that the
Contractor has made good faith efforts to obtain participation from MBE and WBE subcontractors. A finding
of noncompliance or a discriminatory practice shall prohibit that Contractor from being awarded a City
contract for a period of one (1) year from the date of such determination, and such determination may also
be grounds for terminating the contact to which the discriminatory practice or noncompliance pertains.
7. The undersigned Contractor agrees that the following nondiscrimination commitment shall be made
a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its
agencies, boards or commissions.
Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the
performance of this contract with privileges of employment, or any matter directly or indirectly related to
employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation,
handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of
contract.
I, the undersigned bidder or agent as contractor on a public works project, understand my statutory
obligations to the use of steel products or foundry products made in the United States (I.C. 5-16-8-1). I hereby
certify that I and all subcontractors employed by me for this project will use steel products or foundry
products made in the United States on this project if awarded. I understand I have an affirmative duty to
notify the City in my bid that my proposal does not include the use of steel products or foundry products
made in the United States. I understand it is my sole obligation and responsibility to provide a justification
to the City, subject to review and approval, why the cost of United States made steel or foundry products is
unreasonable. Prior to award and upon submission of bid which does not use steel products or foundry
products made in the United States, the City, through its director of public works, shall make a determination
if the price of United States made steel or foundry is unreasonable. I understand that violations hereunder
Version 03/15/2024 Contractor's Bid for Public Works - 5
Bidder: Gibson -Lewis, LLC
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 28th day of May , 20 24
Nick Gurbick, Vice President
Printed Name and Title
Subscribed and sworn to before me(his 28th �Vy of MM , 20 24
My Commission Expires
08/05/2031
County of Residence
Notary Public Juli Hodowaniec
Q
Ll HCDOWANfECO 1� NotaMState ofI Indianan Ncut r NAQ671289fpn kpfres Rug 5, 203 t
Version 03/15/2024 Contractor's Bid for Public Works - 6
Project Name:
Project Number:
For Bids Due:
Contractor Name:
BASE BID
BID/PROPOSAL. r,
CITY OF SOUTH BEND
South Bend - SBCSC Administration Building - Elevator Replacement
124-001 A
28 May 2024
Gibson -Lewis, LLC
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
Furnishing all labor, services, materials,
insurance and
equipment to necessary to demolish
existing elevator equipment and
1
construction of a pair of
1
LS
elevators at South Bend - SBCSC
Administration Building in South Bend
improvements according
to the intent of the plans and
specifications.
Bidder (Firm): Gibson -Lewis, LLC
Address: 1001 W. I Ith Street
City/State/Zip: Mishawaka, IN 46544 Telephone N
By
BASE BID TOTAL
81
Nick Gurbick, Vice President
(Printed Name of Person Signing)
Version 03/15/2024 Contractor's Bid for Public Works - 7
CITY OF SOUTH BEND?
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN i
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:
124-001 A
Project Name: South Bend - SBCSC Administration Building - Elevator Replacement
Gibson -Lewis, LLC Total Bid Amount:
MBE Goal: 0.0
Page of
Name & Address of MBE
Primary Contact Person
(Name/Telephone)
Scope of Work to be Performed
(Attach scope/schedule if you need additional space)
Dollar Amount of MBE
Component
Percentage
of Total
Bid/ProDOSal
Submitted by: Nick Gurbick, Vice President
Print Name
l
Sign care
***Goals should be calculated based on the Base Bid only.***
Version 03/15/2024 Contractor's Bid for Public Works - 8
5/28/24
Date
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM WBE-1.0
WBE UTILIZATION PLAN
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving WBE participation. It is
the bidder's sole responsibility to verify whether any listed woman -owned business meets the WBE qualifications.
***Goals should be calculated based on the Base Bid only.***
Project Number:
Bidder:
124-001 A
Project Name: South Bend - SBCSC Administration Building - Elevator Replacement
Gibson -Lewis, LLC Total Bid Amount:
WBE Goal: 5.0
Page of
Name & Address of WBE
Primary Contact Person
(Name/Telephone)
Scope of Work to be Performed
(Attach scope/schedule if you need additional space)
Dollar Amount of WBE
Component
Percentage
of Total
Bid/Proposal
Submitted by.
Nick Gurbick, Vice President
Print Name
,/-/ LAI
ign ure
***Goals should be calculated based on the Base Bid only.***
Version 03/15/2024 Contractor's Bid for Public Works - 9
5/28/24
Date
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.0
EVIDENCE OF GOOD FAITH EFFORTS
This completed form should be included as part of the Bids documents related to City of South Bend Public
Works Projects requiring Good Faith Efforts to obtain MBE participation.
Project Number: 124-001A Date:
Project Name: South Bend - SBCSC Administration Building - Elevator Replacement
Bidder: Gibson -Lewis, LLC
Contact Person: Nick Gurbick, Vice President Telephone: 574-259-8581
Address: 1001 W. 11th Street
City: Mishawaka State: IN zip: 46544
Email. njzurbickAe1.nceusa.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
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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: hftD://www.in.gov/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
NG
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.aov/idoa).
I affirm that I have made good faith efforts to select portions of the contract work to be
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performed by MWBEs, including, where appropriate, breaking out contract work items into
economically feasible units to facilitate MBE participation.
NG
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.
NG
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
NG
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
NG
reasonably calculated to inform MBEs of subcontracting opportunities and allowed
sufficient time for MBEs to participate effectively.
NG
I affirm that I followed up on initial solicitations with interested MBEs.
NG
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,
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lines of credit, or insurance as required by the City or the bidder, where appropriate.
Version 03/15/2024 Contractor's Bid for Public Works - 10
Bidder: Gibson -Lewis, LLC
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.0
EVIDENCE OF GOOD FAITH EFFORTS
NG
€ 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.
NG
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 03/15/2024 Contractor's Bid for Public Works - 11
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN -
FORM WBE-2.0
EVIDENCE OF GOOD FAITH EFFORTS
This completed form should be included as part of the Bids documents related to City of South Bend Public
Works Projects requiring Good Faith Efforts to obtain MWBE participation.
Project Number: 124-001A Date: 5/28/24
Project Name: South Bend - SBCSC Administration Building - Elevator Replacement
Bidder: Gibson -Lewis, LLC
Contact Person: Nick Gurbick, Vice President Telephone: 574-259-8581
Address: 1001 W. 11th Street
City: Mishawaka State: IN Zip: 46544
Email: ngurbick&l.nceusa.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
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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 ://www.in.aov/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
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Indiana Minority and Women Business Enterprises, found on their website
htt:Ilwww.in. ovlidoa .
I affirm that I have made good faith efforts to select portions of the contract work to be
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performed by WBEs, including, where appropriate, breaking out contract work items into
economically feasible units to facilitate WBE participation.
NG
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.
NG
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
NG
concerning subcontract opportunities and allowed WBEs reasonable time to respond to
such advertisements.
NG
I affirm that I performed any and all necessary steps to provide written notices in a manner
reasonably calculated to inform WBEs of subcontracting opportunities and allowed
sufficient time for WBEs to participate effectively.
NG
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
NG
with adequate information about the plans, specifications and other requirements of the
subcontract.
NG
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 03/15/2024 Contractor's Bid for Public Works - 12
Bidder: Gibson -Lewis, LLC
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM WBE-2.0
EVIDENCE OF GOOD FAITH EFFORTS
rA
�[ e
i affirm that l have made good faith efforts to assist interested WBEs in obtaining
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necessary equipment, supplies, materials, or related assistances or services, where
appropriate.
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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 03/15/2024 Contractor's Bid for Public Works - 13
CITY OF SOUTH BEND`'
lul
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1 f<<;
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,- 124-001A MBE Participation Goal
Project Namtr uth e d - SBCSC Administration Building - Elevator Renlacement
Bidder:
By: __
is, LLC —,—
bick
MBE Firm D.A. Dodd LLC
Vice President
(Title)
5/28/24
(Date)
Owner or Contact at MBE Firm Rob Fisher
Telephone: 219-778-4302 Fax: Email: robfisher@dadodd.com
TYPE OF WORK SOLICITED FOR THIS PROJECT:
HVAC
RESULTS OF CONTACT WITH THE MBE FIRM:
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 03/15/2024 Contractor's Bid for Public Works - 14
CITY OF SOUTH BEND
'
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
"
FORM MBE-2.1
WBE CONTACTED
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects
requiring Good Faith Efforts to contact WBEs. It is the bidder's sole responsibility to verify whether any listed
woman -owned business meets the WBE qualifications. Attach additional pages if necessary.
PAGE OF
Project Number: 124-001A WBE Participation Goal
ProjeVName: S th e - SBCSC Administration Buildin - Elevator Re lacement
Bidde
By: Vice President 5/28/24
igna ure ick Gu lck (Title) (Date)
WBE Firm McMann Electric Inc
Owner or Contact at WBE Firm Terri McMann
Telephone: 574-274-5748 Fax:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Email: terrimcmann@mcmannelectric.com
Electrical
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 03/15/2024 Contractor's Bid for Public Works - 15
Document A31 OTM — 2010
Conforms with The American Institute of Architects AIA Document 310
CONTRACTOR:
(Name, legal status and address)
Gibson -Lewis, LLC
1001 West 11 th Street
Mishawaka, IN 46544
OWNER:
(Name, legal status and address)
City of South Bend, Indiana
227 West Jefferson Blvd.
South Bend, IN 46601
Bond Number: 03992-CNA-24-066
SURETY:
(Name, legal status and principal place of business)
The Continental Insurance Company
151 N Franklin Street
Chicago, IL 60606
State of Inc: Pennsylvania
BOND AMOUNT: Five Percent of Amount Bid (5% of Amount Bid)
This document has important legal
consequences. Consultation with
an attorney is encouraged with
respect to its completion or
modification.
Any singular reference to
Contractor, Surety, Owner or
other party shall be considered
plural where applicable.
PROJECT:
(Name, location or address, and Project number, if any)
South Bend — SBCSC Administration Building Renovation — Elevator Replacement Project #124-001A
The Contractor and Surety are bound to the Owner in the amount set forth above, for the payment of which the
Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and
severally, as provided herein. The conditions of this Bond are such that if the Owner accepts the bid of the Contractor
within the time specified in the bid documents, or within such time period as may be agreed to by the Owner and
Contractor, and the Contractor either (1) enters into a contract with the Owner in accordance with the terms of such bid,
and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a surety admitted in the
jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contract and for
the prompt payment of labor and material furnished in the prosecution thereof; or (2) pays to the Owner the difference,
not to exceed the amount of this Bond, between the amount specified in said bid and such larger amount for which the
Owner may in good faith contract with another party to perform the work covered by said bid, then this obligation shall
be null and void, otherwise to remain in full force and effect. The Surety hereby waives any notice of an agreement
between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver of notice by the
Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for acceptance of bids
specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for an extension beyond
sixty (60) days.
If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall be
deemed to be Subcontractor and the term Owner shall be deemed to be Contractor.
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 inco prated herein. When so
4l,rnishcd, the intent is that this Bond shall be construed as a statutory bond and not as con ton jaw bond.
and sealedithis 17th day of May 1 2024
Juli Hodowaniec
(Surety)
LLC
(Seal)
k W.&biclO, Vice President
I Insurance Company
12 ,, (Seal) -
Annette Audinot
(Title) I KristV S. Bender, Attorney -in -Fact
POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT
Itnow All Men By These Presents, That The Continental Insurance Company, a Pennsylvania insurance company, is a duly organized and existing insurance
company having its principal office in the City of Chicago, and State of Illinois, and that it does by virtue of the signature and seal herein affixed hereby make, constitute
and appoint
Kristin S. Bender , Individually
of Morristown New Jersey , its true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred to sign, seal and execute for
and on its behalf bonds, undertakings and other obligatory instruments of similar nature
- In Unlimited Amounts -
Surety Bond Number:
Principal; Glbsc
03992-C NA-24-066
Obligee: City of South Bend, Indiana
and to bind them thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the insurance company and all the acts of said
Attorney, pursuant to the authority hereby given is hereby ratified and confirmed.
This Power of Attorney is made and executed pursuant to and by authority of the By -Laws and Resolutions, printed below, duly adopted, as indicated, by the Board of
Directors of the insurance company.
In Witness Whereof, The Continental Insurance Company has caused these presents to be signed by its Vice President and its corporate seal to be hereto affixed on
this 13th day of March, 2024.
The Continental Insurance Company
xn c-
:J j
Larry Kasten Vice President
State of South Dakota, County of Minnehaha, ss:
On this 13th day of March, 2024, before me personally came Larry Kasten to me known, who, being by me duly sworn, did depose and say: that he resides in the City
of Sioux Falls, State of South Dakota; that he is a Vice President of The Continental Insurance Company, a Pennsylvania insurance company, described in and which
executed the above instrument; that he knows the seal of said insurance company; that the seal affixed to the said instrument is such corporate seal; that it was so affixed
pursuant to authority given by the Board of Directors of said insurance company and that he signed his name thereto pursuant to like authority, and acknowledges same to be
the act and deed of said insurance company.
M, BENT,,,,,,.
,(RNOrAAY PIIBLIC�+
S%TN ❑AYOTA S L
i
My Commission Expires March 2, 2026 M. Bent Notary Public
CERTIFICATE
I, Paula Kolsrud, Assistant Secretary of The Continental Insurance Company, a Pennsylvania insurance company, do hereby certify that the Power of Attorney herein
above set forth is still in force, and further certify that the By -Laws and Resolutions of the Board of Directors of the insurance company printed below are still in force. In
testimony whereof have hereunto subscribed my name and affixed the seal of the said insurance company this 17th day of May 2024
The Continental Insurance Company
to ..
Paula Kolsrud Assistant Secretary
Authorizing By -Laws and Resolutions
ADOPTED BY THE BOARD OF DIRECTORS OF THE CONTINENTAL INSURANCE COMPANY:
This Power of Attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the Board of Directors of the Company at a
meeting held on May 10, 1995.
"RESOLVED: That any Senior or Group Vice President may authorize an officer to sign specific documents, agreements and instruments on behalf of the
Company provided that the name of such authorized officer and a description of the documents, agreements or instruments that such officer may sign will be
provided in writing by the Senior or Group Vice President to the Secretary of the Company prior to such execution becoming effective."
This Power of Attorney is signed by Larry Kasten, Vice President, who has been authorized pursuant to the above resolution to execute power of attorneys on behalf ofThe
Continental Insurance Company.
This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the Company by
unanimous written consent dated the 251h day of April, 2012:
"Whereas, the bylaws of the Company or specific resolution of the Board of Directors has authorized various officers (the "Authorized Officers") to execute various
policies, bonds, undertakings and other obligatory instruments of like nature; and
Whereas, from time to time, the signature of the Authorized Officers in addition to being provided in original, hard copy format, may be provided via facsimile or
otherwise in an electronic format (collectively, "Electronic Signatures"); Now therefore be it resolved: that the Electronic Signature of any Authorized Officer shall be
valid and binding on the Company."
This Power of Attorney may be signed by digital signature and sealed by a digital or otherwise electronic -formatted corporate seal under and by the authority of the
following Resolution adopted by the Board of Directors of the Company by unanimous written consent dated the 27th day of April, 2022:
"RESOLVED: That it is in the best interest of the Company to periodically ratify and confirm any corporate documents signed by digital signatures and to ratify and
confirm the use of a digital or otherwise electronic -formatted corporate seal, each to be considered the act and deed of the Company."
Form F6850-2/2024
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
CHECKLIST FOR BIDDERS
Project Name
Project No.
For Bids Due
South Bend - SBCSC Administration Building - Elevator Replacement
124-001 A
28 May 2024
From time to time the South Bend Board of Public Works finds it necessary to reject a bid because
it does not comply with statutory requirements. In preparing your bid, please use the following
checklist in order to make sure that your bid is done in the proper manner.
Proper bid security included. The bidder has the option of providing either a Certified Check
X or Bid Bond.
Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely
X executed.
Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments
with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and
X Certification of use of United States Steel Products or Foundry Products.
Proof of M/WBE Utilization Plans [MBE-1.0 and WBE-1.0]. Also provide Evidence of Good
Faith Efforts Forms [MBE-2.0 and WBE-2.0] and M/WBE Contacted Forms [MBE-2.1 and
X WBE-2.11.
X Acknowledge Receipt of 1 Addendum(s) included with the bid.
X All required additional information is included with the bid.
Proposal statements and other affidavits all signed by the proper party with name either
X printed or typed underneath signature.
X This checklist submitted with the Bid.
This checklist is provided for bidder's use in assuring compliance with required
documentation; however, it does not include all specifications requirements and does not
relieve the bidder of the need to read and comply with the specifications.
Bidder: Gibson-L
By Authorized Rep
Signature:
Print Name & Title:
ick Gbt`W& Ville President
Version 03/15/2024 Contractor's Bid for Public Works - 1
Date: 5/28/24
E-VERIFY COMPLIANCE AFFIDAVIT
The undersigned being duly sworn upon (his)(her) oath, now says that I, Nick Gurbick (name),
Vice President (position) at
do hereby state that
Gibson -Lewis, LLC
Gibson -Lewis, LLC (business entity),
.(business entity) does not
knowingly employ unauthorized aliens and participates in the E-Verify Program when it hires
new employees to confirm their work eligibility.
I swear orfdffirnp4Td/r the penalties for perjury, that the foregoing statements are true.
Nidk G rbick, ViceWresident
Signatu f affiant (include title and name of business entity)
WITNESS my hand and notarial
My commission expires:
08/05/2031
My county of residence is: St. Joseph
Signature.
Juli Hodowaniec
(Printed Signature)
Notary Public ,
StJ Not ��Q41'AIVI�
°�Ph C"ryounbij, ..5
041
MY co, cornmIssf tY "Stag, of 1
�n+►s �� Number "067128agna
n �xFfreSpy� 5 �za37
EQUAL EMPLOYMENT OPPORTUNITY POLICY
GIBSON-LEWIS, LLC has adopted the following policy on equal employment opportunity:
The Company will not discriminate against any employee or applicant for employment
because of race, color, religion, sex, age, national origin, disability, citizenship status,
genetic information, ancestry, off -duty tobacco use, sealed or expunged arrest or conviction
record and veteran status or any other basis protected by state, federal or other applicable
law. The company is also committed not to discriminate regarding the following:
Referral, Hiring, Placement, Upgrading, Promotion, Transfer, Demotion, or Award of
Tenure:
• Recruitment, Advertising, Solicitation for Employment, or Job Application Procedures;
• Rates of Pay or other Forms of Compensation and Changes in Compensation;
• Treatment during Employment;
• Job Assignments, Job Classifications, Organizational Structures, Position
Descriptions, Lines of Progression, and Seniority Lists;
• Leaves of Absence, Sick Leave, or any other Leave;
• Fringe Benefits Available by Virtue of Employment, Whether or Not Administered by
the Company;
• Activities Sponsored by the Company including Social or Recreational Programs;
- Selection and Financial Support for Training including Apprenticeship, Professional
Meetings, Conferences, and other Related Activities and Selection for Leave of
Absence to Pursue Training;
Layoff or Termination; Right to Return from Layoff, Rehire, and all other Terms and
Conditions of Employment
The Company further agrees to provide a reasonable accommodation to any otherwise
qualified individual with a disability unless the accommodation would cause an undue
hardship, as and to the extent required by the Americans with Disabilities Act.
The Company also seeks and intends to achieve and maintain full compliance with all other
applicable statutes, regulations and executive orders on equal employment opportunity.
THE COMPANY EXPECTS ALL EMPLOYEES TO ABIDE BY THIS POLICY.
�'T
4 y
� I
bx y�
r�t: Sir
1316 COUNTY -CITY BUILDING w �`' '' PHONE 574/ 235-9251
227 W. JEFFERSON BOULEVARD x FAX 574/ 235-9171
SOUTH BEND, INDIANA 46601-1830 TDD 574/ 235-5567
CITY OF SOUTH BEND, JAMES MUELLER, MAYOR
BOARD OF PUBLIC WORKS
Date:
To:
From
Subject
May 23, 2024
All Planholders
Theresa Heffner, Clerk, Board of Public Works
Addendum Number: 1
Project Name: South Bend — SBCSC Administration Building Renovation — Elevator
Replacement
Project Number: 124-001A
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM
Date Received: 5/24/24
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.
Date: 5/24/24
Version 4/2/2015
General Form No. 96-a
Prescribed by the State
Board of Accounts of Indiana
Revised 1949
STANDARD QUESTIONNAIRES AND
FINANCIAL STATEMENT FOR BIDDERS
Prescribed by
THE STATE BOARD OF ACCOUNTS OF INDIANA
For use in investigating and determining the qualifications of bidders on public Finance
construction when the aggregate cost of any such work or improvement will be
Five Thousand Dollars or more.
These statements to be submitted under oath by each bidder with and as a part
of his bid, as provided by Chapter 306, page 1248, Acts of 1947.
OWNER: City of South Bend, Indiana
227 West Jefferson Blvd
South Bend, IN 46601
PROJECT: SBCSC Administration Building Renovation
Elevator Replacement — Project #124-001A
South Bend, IN
SUBMITTED BY:
GIBSON-LEWIS, LLC
1001 W. 11th. Street
Mishawaka, Ind. 46544
DATE: May 28, 2024
Filed:
O A Corporation
() A Co -partnership
() An Individual
(X) A Limited Liability Company
The following forms of questionnaires and financial Statement are prescn"bed by the State
Board of Accounts in con.Cornuty with the statufe set out on the proceeding page.
These forms, properly filled out and attested, must accompany each bid of Five Thousand
Dollars or more on any public work.
The foms are designed to cover all contracts for all kinds of work and the bidder is
required to answer such questions as are pertinent to the work upon which he is bidding.
The purpose of the questionnaire and financial statement, as set forth m the law, is to
enable the awarding body to determine the qualifications of the bidder to cant' out
successfully the contract if the same is awarded to him.
The bidder will find it to his advantage to answer fully all questions coming within the
range of the work upon which he is bidding_ Particular attention should be given the
"-Financial Statement" and the details relative to the assets and liabilities set out. This
form is made in extensive detail so that the bidder may explain his assets and liabilities in
proper sequence and in a uniform manner.
Section 2 of an Act entitled "An ACT concerning the awarding for the performance of
public work and authorizing the board of accounts to prescribe certain forms to be used in
ascertaining the responsibility of contractors who submit bids for the performance of such
work, providing for plans and specifications, providing for bids repealing certain laws
and declaring an emergency".
Section 2. Whenever the aggregate costs of any work or improvement will be five
thousand dollars ($5,000.00) or more, for the purpose of enabling such board,
commission, trustee, officer or agent to ascertain and determine which of the bidders
submitting bids for the performance of any such public work is, in the judgement of such
board, commission, trustee, officer or agent, the lowest and/or best bidder and to exercise
intelligently the discretion hereby conferred on such board, commission, trustee, officer
or agent, each bidder shall be required to submit under oath with and as a part of his bid,
a statement of his experience, his proposed plan for performing such work and the
equipment which he has available for the performance of such work and a financial
statement. The statements, hereby required shall be submitted on forms which shall be
prescribed by the state board of accounts. The forms so prescribed shall be designated,
respectively, as the experience questionnaire, the plan and equipment questionnaire and
the contractor's financial statement, and shall be based, so far as applicable, on the
standard questionnaires and financial statement for the bidders as approved and
recommended by the joint conference on construction practices, for use in investigating
the qualifications of bidders on public construction work, and the forms so prescribed are,
hereby, prescribed as the fonts which shall, hereafter, be used by all such boards,
commissions, trustees, officers and agents in obtaining the information which is required
in the administration of this act. If the information stibmilted by any bidder on the forms
herein prescribed is found, on examination, to be unsatisfactory, the bid submitted by
such bidder shall not be considered.
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
RESPONSIBLE BIDDER CHECKLIST
Project Name South Bend - SBCSC Administration Building - Elevator Replacement
Project No. 124-OOIA
For Bids Due Mav 28. 2024
Contractor Name: Gibson -Lewis, LLC
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.
"THIS FORM ONLY APPLIES TO BIDS GREATER THAN $250,000. **
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-
71 of The Responsible Bidding Ordinance No. 10975-23 (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") 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 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 6-71 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 6-71 of the Responsible Bidding Ordinance no later than the date of the public bid
opening.
Version 5/20/2024 General Conditions - 11
Bidder: Gibson -Lewis, LLC
POST BID SUBMISSIONS:
Post -bid submissions must be submitted in accordance with Section 6-72 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 t id 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 two -hundred fifty
thousand dollars ($250,000.00), 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 for projects greater than $250,000 and all subcontractors performing work
greater than $250,000 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 5/20/2024 General Conditions - 12
Bidder: Gibson -Lewis, LLC
PRE -QUALIFIED BIDDER CHECKLIST
(a) Acknowledgements:
0) X By checking this box, I hereby acknowledge that I am a pre -qualified bidder with
the City of South Bend and that I have met the pre -qualification requirements within
the last twelve (12) months. A copy of my Pre -Qualification verification letter
is attached.
(ii) X By checking this box, I hereby acknowledge that the City reserves the right to
request supplemental information, additional verification of any information
provided by me, and may also conduct random inquiries of my current and prior
customers.
(iii) X By checking this box, I hereby acknowledge that apprenticeship and training
programs that I participate in have graduated at least five (5) apprentices in each
of the past five (5) years.
(iv) X By checking this box, I hereby acknowledge that all subcontractors performing
work greater than $250,000 also meet the qualifications of the Responsible Bidder
Ordinance.
(b) Attachments:
(i) X Indiana Secretary of State's on-line records (ie. Business verification) dated within
sixty (60) days of the submission of said document showing that business is in
existence, current with the Indiana Secretary of State's Business Entity Report,
and eligible for a certificate of good standing. (Not applicable to individuals, sole
proprietors or partnerships).
(ii) X Statement on staffing capabilities, including labor sources. This statement
indicates and ensures I have sufficient employees on staff to complete the work. It
outlines how I intend to meet the staffing needs of the work.
(iii) X List of projects of similar size and scope of work performed in all areas, including
the State of Indiana, within the last three (3) years.
(iv) X For every project, submit evidence of participation in apprenticeship and training
programs, applicable to the work to be performed on the project, which are
approved by and registered with the United States Department of Labor's Office of
Apprenticeship, or its successor organization. This includes, but may not be limited
to, letters from apprenticeship coordinators detailing the bidder's association with
the program, and the United States Department of Labor Office of Apprenticeship
Certificates of Registration of Apprenticeship Programs for each type of work to be
performed on the project.
(ii) Gibson -Lewis, LLC will provide qualified leadership and tradesman from a pool of experienced employees
to meet the requirements of the project. Long standing relationship with various craftsman unions including
carpenters, Iaborers, cement masons, plasterers and painters.
Version 5/20/2024 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, 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.
(v) _ By checking this box, I hereby acknowledge that apprenticeship and training
programs that I participate in have graduated at least five (5) apprentices in each
of the past five (5) years.
(vi) _ By checking this box, I hereby acknowledge that all subcontractors performing
work greater than $250,000 also meet the qualifications of the Responsible Bidder
Ordinance.
(b) Attachments:
0)
(ii)
(iii)
(iv)
(v)
(v)
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).
List identifying all former business names.
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.
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.
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.
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. This includes, but may not be limited
to, letters from apprenticeship coordinators detailing the bidder's association with
Version 5/20/2024 General Conditions - 14
the program, and the United States Department of Labor Office of Apprenticeship
Certificates of Registration of Apprenticeship Programs for each type of work to be
performed on the project.
(vi) 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.
(vii) 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.
(viii) _ 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.
(ix) _ 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
Nick Gurbick, Vice President
(Print Name Here)
Gibson -Lewis, LLC
(Name of Company)
1001 W. I Ith Street
(Address of Company)
Mishawaka
(City)
Indiana
(State)
574-259-8581
(Telephone Number)
Version 5/20/2024 General Conditions - 15
CTTY OF SOUTH BEND JAMES MUELLER, MAYOR
DEPARTMENT OF PUBLIC WORKS
ERIC HORVATH, DIRECTOR
October 3, 2023
Juli Hodowaniec
Gibson -Lewis
.1110dowa11iec ct} L11ceusa.colsi
RE: Pre -Qualification Verification
Dear Ms. Hodowaniec:
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,
Theres�Icahcr, Clerk
Board of Public Works
BUSINESS INFORMATION
DIEGO MORALES
INDIANA SECRETARY OF STATE
05/10/2024 11:17 AM
Business Name: GIBSON-LEWIS, LLC Business ID: 1995051381
Entity Type: Domestic Limited Liability Company Business Status: Active
Creation Date: 05/24/1995
Inaclke Date:
Principal Office Address: 1001 W. I Ith, MISHAWAKA, IN. 46544, Expiration Date: Perpetual
USA
Jurisdiction of Formation: Indiana Business lintity Report Due 05/31/2025
Date:
Years Due:
glstered Agent lnfQrMajus
Type: Business
Name: NATIONAL CONSTRUCTION ENTERPRISES INC.
Address: 1001 W. l l th, Mishawaka, IN, 46544 - 0000, USA
AIA Document A305
Contractor's Qualification Statement
1986 EDITION
This form is approved and recommended by the American Institute of Architects
(AIA) and The Associated General Contractors of America (AGC) for use in
evaluating the qualifications of contractors. No endorsement of the submitting
party or verification of the information is made by the AIA or AGC.
The Undersigned certifies under oath that the information provided herein is true and sufficiently complete so
as not to be misleading.
SUBMITTED TO: City of South Bend, Indiana
Board of Public Works
ADDRESS: 227 W. Jefferson Blvd
South Bend, IN 46601 Corporation
SUBMITTED BY:
NAME:
ADDRESS:
PRINCIPAL OFFICE:
Gibson -Lewis, LLC
1001 W. 11th Street
Mishawaka, IN 46544
Partnership
Individual
Joint Venture
Other
Limited Liability Company
NAME OF PROJECT: SBCSC Administration Building Renovation - Elevator Replacement
Project #124-001A
TYPE OF WORK:
X General Construction HVAC
Plumbing Electrical
Other
(Please specify)
Co ri ht 1964. 1969. 01986 by The American Institute of Atc:hltects, 1735 New York Avemic, N.W, 1Vashin 1�
Is. RrprOlt netlan of t tc mate ui I licircin or su aunnia I goottttiun or 116 provtrwns wI1 emit written pennlssiOil
the AIA violates the copyright laws of the Uni led States and will be subject to legal prosecution.
AIA DOCUMENT A305 -CONTRACTOR'S QUALIFICATION STATEMENT - 1986 EDITION -AIAV -101986
THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W. WASHINGTON, D.C. 20006 A305-1986 1
Gibson -Lewis, LLC
1. ORGANIZATION
1.1 How many years has your organization been in business as a Contractor?
56 years
1.2 How many years has your organization been in business under its present business name?
28 years
1.2.1 Under what other former names has your organization operated?
Gibson -Lewis, Inc. was incorporated into LLC in 1995
1.3 If your organization is a corporation, answer the following:
1.3.1
Date of incorporation:
1.3.2
State of incorporation:
1.3.3
President's name:
1.3.4
Vice-president's name:
1.3.5 Secretary's name:
1.3.6 Treasurer's name:
1.4 If your organization is a partnership, answer the following:
1.4.1 Date of organization:
1.4.2 Type of partnership:
1.4.3 Names) of general partner(s):
1.5 If your organization is individually owned, answer the following:
l .5.1 Date of organization:
I.5.2 Name of owner:
AIA vOCIIMENT A306 • CON'I'KAC-rOR'S QUAI_IEIC'ATION STAt"I:MENT - I986 FnfrION • AIAV -01986 A305.1986 2
THEA,WRICANLNSIICUTE OFARciurF:CT5,1735NI:WYORKAVENUE, N.W.WAS}nw(irmu-C.20506
Gibson -Lewis, LLC
1.6 If the fomt of your organization is oQur than those listed above, desaribe it and Heine the principals!
Robert A. Lingenfelter
James E. Nagle
Nicholas A. Gurbick
Elizabeth Biddle
2. LICENSING
- President
- Vice President
- Vice President
- Assistant Secretary
2.1 List jurisdictlons and tntde categories in which ytitlr organization is legally qualified to do business,
and (ndicnte registration or Iiccnse munbers, if applicable:
Indiana and Michigan
2.2 List jurisdictions in which your organization's partnership or trade name is filed.
3. EXPERIENCE
3.1 List the categories of work that your organization normally porforins with its own forces.
Metal Framing, Drywall, Drywall Finishing, Insulation, Plastering, Acoustical Ceilings,
Firestopping, Concrete, Carpentry, Painting, and Selective Demolition
3.2 Claims and Suits. (If Iltc answer to any of Ilse questions below is yc-�, please ultach details,)
3.2.1 Yras your org oniztnion ever failed to colilpleio any work awcrrdvd to it?
No
3,2.2 Are share any judgments, claims, arbitration proceedings or suits pending or outstanding
against your organization or it's officers?
No
3,2.3 Hus your organization filed any law suits or requested arbitration with regard to
ous rua ton con me s W1111111 the 1lisf live yours
No
AIA DOCUMENT A300 •C(INTRACI'OR-SQUALIVICATIONSTA'IZMENT-1796WIYION •AIA-0-C H6 A305-1986 3
711E AMIIRICAN rNsrnWe QV ARCHIPECT6, 1733 NUW YORK AVrt1UE t4,W. WASIIINCITON,1].C, laaa6
Gibson -Lewis, LLC
3.3 Within the last five years, has any officer or principal of your organization ever been an officer or
Principal of another organization when it failed to complete a construction contract? (If the
answer is yes, please attach details.)
No
3.4 On a separate sheet, list major construction projects your organization has in progress, giving the
name of project, owner, architect, contract amount, percent complete and scheduled completion date.
Please see attached
3.4.1 State total worth of work in progress and under contract:
3.5 On a separate sheet, list the major projects your organization has completed in the past five years,
giving the name of project, owner, architect, contract amount, date of completion and percentage of the
cost of work performed with your own forces. Please see attached
3.5.1 State average annual amount of construction work performed in the past five years:
3.6 List the construction experience and present commitments of the key
individuals of your rrganization.
Please see attached
4. REFERENCES
4.1 Trade References:
Foundation Building Materials
5203 Division Avenue
Grand Rapids, MI 49548
L & W Supply
1401 S Main Street
South Bend, IN 46613
Big C Lumber Company
50860 Princess Way
Granger, IN 46530
4.2 Bank References:
Wheaton Bank & Trust
211 South Wheaton Avenue
Wheaton, IL 60187
Office: 630-456-7853
Fax: 630-690-7715
4.3 Surety:
Phone: 616-534-4904
Fax: 616-724-2651
Phone: 574-289-5566
Fax: 574-289-5569
Phone: 574-277-4670
Fax: 574-271-3834
AIA DOCUMENT A305 • CONTRACTOR'S QUALIFICATION STATCMCNT • 1986 EDIt ION • AIA-E • 01966
THE AMERICAN INSTrrUTCOFARCIII"I'ECTS, 1735NEW YORKAVCNUC,N.W. WASIIING'rON,D.C.20006 A305-1986 4
Gibson -Lewis, LLC
4.3.1 Name of bonding company:
The Continental Insurance Company
CNA Plaza - Chicago, IL 60603
4.3.2 Name and address of agent -
Marsh USA, Inc. Daniel Machado
One Towne Square, STE 1100
Southfield, MI 48076
5. FINANCING
5.1 Financial Statement.
5.1.1 Attach a financial statement, preferably audited, including your organization's latest balance
sheet and income statement showing the following items:
Current Assets (e.g., cash, joint venture accounts, accounts receivable, notes
receivable, accrued income, deposits, materials, inventory and prepaid expenses);
Please see attached
Net Fixed Assets;
Other Assets;
Current Liabilities (e.g., accounts payable, notes payable, accrued expenses,
provision for income taxes, advances, accrued salaries and accrued payroll taxes);
Other Liabilities (e.g., capital, capital stock, authorized and outstanding shares par
values, earned surplus and retained earnings).
5.1.2 Name and address of firm preparing attached financial statement, and date thereof:
Crowe LLP - 330 E. Jefferson Blvd, South Bend, IN 46601
5.1.3 Is the attached financial statement for the identical organization named on page one?
Yes
5.1.4 If not, explain the relationship and financial responsibility of the organization whose fmancial
statement is provided (e.g., parent -subsidiary).
5.2 Will the organization whose financial statement is attached act as guarantor of the contract for
Construction ?
Yes
AIA DOCUMENT A305 - CONTRACTOR'S QUALIFICATION STATEMENT - 1986 EDITION - AIAM - 01986 A305-1986 5
THE AMERICAN INSTITUTE OF ARCWrECTS, 1735 NEW YORK AVENUE, N,W. WASHINGTON, D.C. 20006
Officer
Robert A. Lingenfelter
James E. Nagle
Nicholas A. Gurbick
Elizabeth Biddle
KEY PERSONNEL
# of Years
Title Experience
President 34 Years
Vice President 38 Years
Vice President 11 Years
Assistant Secretary 23 Years
OTHER STATE WORK, LOCAL GOVERN MENT WORK AND U.S. GOVERNMENT WORK
PERFORMED WITHIN
THE PAST FIVE YEARS OVER $150.000.00.
Name of Government Entity
6 Digit
$ Amount
Year
Catergory No.
Started/Completed
Notre Dame Rolf's BB Practice Facility
1542.01
$714,000
Completed 2019
Notre Dame. Indiana
Notre Dame Decio Hall
1542.01
$731,000
Completed 2019
Notre Dame, Indiana
Beacon Health Niles Ave
1542.01
$457,000
Completed 2019
South Bend, Indiana
Elkhart Health & Fitness
1542.01
$2,431,000
Completed 2019
Elkhart, Indiana
Dowagiac Union Schools
1542.01
$1,879,000
Completed 2019
Dowagiac, Michigan
Valparaiso HS Natatorium
1542.01
$565,000
Completed 2019
Valparaiso, Indiana
Brandywine HS Gymasium
1542.01
$1,840,000
Completed 2019
Niles, Michigan
Elkhart County Juvenile Center
1542.01
$168,000
Completed 2019
Elkhart, Indiana
Notre Dame Utilities Doc
1542.01
$562,000
Completed 2019
Notre Dame, Indiana
Starke Co Office Elevator
1542.01
$291,000
Completed 2019
Knox, Indiana
Concord Schools Health & Fitness
1542.01
$3,921,000
Completed 2019
Elkhart, Indiana
Notre Dame Quarknet
1542.01
$600,000
Completed 2019
Notre Dame, Indiana
Beacon Hospital
1542.01
$1,214,000
Completed 2019
Granger, Indiana
Notre Dame Maintenance Building
1542.01
$207,000
Completed 2019
Notre Dame, Indiana
Memorial Hospital Epworth JC
1542.01
$824,000
Completed 2019
South Bend, Indiana
Memorial Hospital ICU Casework
1542.01
$245,000
Completed 2019
South Bend. Indiana
Memorial Hospital 3S Patient Tower
1542.01
$759,000
Completed 2019
South Bend, Indiana
St Joe Med Center PST Infusion
1542.01
$161,000
Completed 2019
Mishawaka, Indiana
St Joe Med Center EMS Conf. Room
1542.01
$158,000
Completed 2019
Mishawaka, Indiana
Elkhart Gen Hosp IR Remodel
1542.01
$762,000
Completed 2019
Elkhart, Indiana
Memorial Hospital Cath Lab #2
1542.01
$440,000
Completed 2019
South Bend, Indiana
Prairie Heights ES/MS
1542.01
$298,000
Completed 2019
LaGrange, Indiana
Beacon Hospital 24 hr Urgent Care
1542.01
$288,000
Completed 2019
Mishawaka, Indiana
PHM Schools PSI
1542.01
$367,000
Completed 2019
Osceola, Indiana
Niles Child Development Center
1542.01
$1,272,000
Completed 2019
Niles, Michigan
Memorial Hospital Main Pharmacy
1542.01
$366,000
Completed 2019
South Bend, Indiana
Lake Michigan College Mendel Ctr
1542.01
$506,000
Completed 2019
Benton Harbor, Michigan
Columbia City High School
1542.01
$8,700,000
Completed 2020
Columbia City, Indiana
Lincoln JR HS General Trades
1542.01
$10,500,000
Completed 2020
Plymouth, Indiana
Lake Michigan College Napier Bldg
1542.01
$440,000
Completed 2020
Benton Harbor, Michigan
Purdue Univ Bioscience Building
1542.01
$2,000,000
Completed 2020
Hammond, Indiana
Notre Dame Corby Hall
1642.01
$380,000
Completed 2020
Notre Dame, Indiana
Elkhart Gen Hosp Radiology/Oncology
1542.01
$2,100,000
Completed 2020
Elkhart, Indiana
LaPorte Hospital Exterior Panels
1542.01
$266,000
Completed 2020
LaPorte, Indiana
Van Buren ISD Tech Center
1542.01
$169,000
Completed 2020
Lawrence, Michigan
Beacon Orthopedics
1542.01
$1,922,000
Completed 2020
South Bend, Indiana
South Bend Airport Terminal Update
1542.01
$619,500
Completed 2020
South Bend, Indiana
Beacon Bristol Street PEDS
1542.01
$152,000
Completed 2020
Elkhart, Indiana
Memorial Hospital 4th Floor Mother Baby
1542.01
$209,000
Completed 2020
South Bend, Indiana
Beacon Ireland Road
1542.01
$225,000
Completed 2020
Granger, Indiana
Notre Dame Fischer Community Center
1542.01
$219,000
Completed 2020
Notre Dame, Indiana
South Bend Fire Station #3 & #6
1542.01
$1,000,000
Completed 2020
South Bend, Indiana
Elkhart General Cafeteria Remodel
1542.01
$1,017,000
Completed 2020
Elkhart, Indiana
Notre Dame McCourtney Labs
1542.01
$3,268,000
Completed 2020
Notre Dame, Indiana
Century Center Elevator
1542.01
$168,700
Gompleted 2021
South Bend, Indiana
Beacon Pharmacy
1542.01
$210,000
Completed 2021
Bremen, Indiana
Morris Theater
1542.01
$346,000
Completed 2021
South Bend, Indiana
Union Substation Upgrade
1542.01
$246,000
Completed 2021
Mishawaka, Indiana
Cleveland Twp Fire Station
1542.01
$4,449,000
Completed 2021
Elkhart, Indiana
Dowagiac Libraries
1542.01
$1,236,000
Completed 2021
Dowagiac, Michigan
Merrillville Community Rec Center
1542.01
$822,000
Completed 2021
Merrillville, Indiana
Elkhart Schools 2020 Improvements
1542.01
$8,160,000
Completed 2021
Elkhart, Indiana
Penn Harris Madison Science & Fitness
1542.01
$3,098,000
Completed 2021
Mishawaka, Indiana
Goshen Admin Chandler School
1542.01
$189,000
Completed 2021
Goshen, Indiana
Memorial Hospital Lin Acc Vault #3
1542.01
$499,000
Completed 2021
South Bend, Indiana
Ivy Tech Advanced Manuf. Lab
1542.01
$517,000
Completed 2021
Elkhart, Indiana
New Buffalo Twp Public SaTety Bldg
1542.01
$1,042,000
Completed 2021
New Buffalo, Michigan
Lakeland Ortho Bariatrics
1542.01
$313,000
Completed 2021
St. Joseph, Michigan
Memorial Hospital Physicians Lounge
1542.01
$286,000
Completed 2021
South Bend, Indiana
Penn Harris Support Services Center
1542.01
$318,000
Completed 2021
Mishawaka, Indiana
Notre Dame Leighton Hall IP Clinic
1542.01
$257,000
Completed 2021
Notre Dame, Indiana
Notre Dame O'Shaughnessy Phase II
1542.01
$158,000
Completed 2021
Notre Dame, Indiana
Bremen Isolation Room
1542.01
$227,000
Completed 2021
Bremen, Indiana
Warsaw High School Upgrades
1542.01
$158,000
Completed 2021
Warsaw, Indiana
Memorial Hospital 1st Floor Corridor
1542.01
$307,000
Completed 2021
South Bend, Indiana
Notre dame O'Shaughnessy 3rd Flr PLS
1542.01
$737,000
Completed 2021
Notre Dame, Indiana
Memorial Hospital IR #2
1542.01
$234,000
Completed 2021
South Bend, Indiana
Lakeland Hospital Prep Recovey Demo
1542.01
$3,054,000
Completed 2021
St. Joseph, Michigan
Three Rivers Andrews & Norton E.S.
1542.01
$530,000
Completed 2022
Three Rivers, Michigan
Three Rivers Park & Hoppins E.S.
1542.01
$933,000
Completed 2022
Three Rivers, Michigan
Mishawaka Town Hall
1542.01
$2,218,000
Completed 2022
Mishawaka, Indiana
Concord Schools Press Box
1542.01
$449,000
Completed 2022
Elkhart, Indiana
Beacon Epworth 3rd Floor
1542.01
$593,000
Completed 2022
South Bend, Indiana
Lakeland Hospital GME
1642.01
$423,000
Completed 2022
Niles, Michigan
Oak Hills Schools BB Field Complex
1542.01
$3,459,000
Completed 2022
Converse, Indiana
Fairview Elementary School
1542.01
$3,046,000
Completed 2022
Logansport, Indiana
Notre Dame Religious Libel Clinic
1542.01
$301,000
Completed 2022
Notre Dame, Indiana
Jackson M.S. Secure Ents & Office
1542.01
$1,417,000
Completed 2022
South Bend, Indiana
Notre Dame Coleman Morse
1542.01
$224,000
Completed 2022
Notre Dame, Indiana
Notre Dame Wellness Addition
1542.01
$2,114,000
Completed 2022
Notre Dame, Indiana
Fulton County Courthouse
1542.01
$217,000
Completed 2022
Rochester, Indiana
Penn Harris Madison 2022 Windows
1542.01
$340,000
Completed 2022
Mishawaka, Indiana
Penn Harris Madison Elm Rd Elem
1542.01
$156,000
Completed 2022
Mishawaka, Indiana
Notre Dame Hesburgh Reading Room
1542.01
$571,000
Completed 2023
Notre Dame, Indiana
Lakeland Hospital Cardio
1542.01
$175,000
Completed 2023
St Joseph, Michigan
Notre Dame Glynn Family Honors
1542.01
$492,000
Completed 2023
Notre Dame, Indiana
Notre Dame Stayer Center Lounge
1542.01
$906,000
Completed 2023
Notre Dame, Indiana
Memorial Hospital Starbucks
1542.01
$477,000
Completed 2023
South Bend, Indiana
Bremen Schools Envelope
1542.01
$2,994,000
Completed 2023
Bremen, Indiana
Muessel Grove Park Restroom
1542.01
$398,000
Completed 2023
South Bend, Indiana
Crown Point Middle School
1542.01
$3,899,000
Completed 2023
Winfield, Indiana
Homestead High School
1542.01
$926,000
Completed 2023
Fort Wayne, Indiana
Hanover Elementary School
1542.01
$4,750,000
Completed 2023
Cedar Lake, Indiana
Juday Creek Water Treatment Plant
1542.01
$260,000
Completed 2023
Granger, Indiana
Northridge HS Renovation/Addition
1542.01
$4,195,000
Completed 2023
Middlebury, Indiana
Beacon Hospital ASC
1542.01
$334,000
Completed 2023
Granger, Indiana
Beacon Hospital Riverpointe NCN
1542.01
$971,000
Completed 2023
Elkhart, Indiana
Ironworks Plaza
1542.01
$707,000
Completed 2023
Mishawaka, Indiana
Northricigs HS Athletic Addition
1542.01
$2,276,000
Completed 2023
Middlebury, Indiana
Penn HS Bleacher Replacement
1542.01
$639,000
Completed 2023
Mishawaka, Indiana
Lakeland Hospital Neurosurgery
1542.01
$622,000
Completed 2023
St Joseph, Michigan
Monger Elementary
1542.01
$4,598,000
Completed 2023
Elkhart. Indiana
Tippecanoe Valley HS
1542.01
$7,936,000
In Process
Akron, Indiana
Four Winds Player Facility
1542.01
1,426,868.00
Completed 2023
South Bend, Indiana
Notre Dame New Men's Residence Hall
1542.01
1,896,057.20
In Process
Notre Dame, Indiana
Wa-Nee Connector/Transportation Bldg
1542.01
857,374.82
In Process
Nappannee, Indiana
Notre Dame Facilities 2nd Floor
1542.01
151,924.00
Completed 2023
Notre Dame, Indiana
Corewell Health
1542.01
241,329.00
In Process
Benton Harbor, Michigan
Memorial Hospital Cath Lab #1
1542.01
392,589.48
Completed 2023
South Bend, Indiana
University of Notre Dame DeBartolo 101 Auditoi
1542.01
360.044.00
Completed 2023
Notre Dame, Indiana
Union Center Elementary School
1542.01
347,140.00
In Process
Valparaiso, Indiana
Three Rivers Middle School
1542.01
1,808,128.00
In Process
Three Rivers, Michigan
University of Notre Dame Decio 3rd floor
1542.01
1,271,382.00
In Process
Notre Dame, Indiana
PHM Moran and Mary Frank E.S.
1542.01
1,006,500.00
In Process
Mishawaka, Indiana
PHM Penn High School CPA & Fine Arts
1542.01
2,449,643.50
In Process
Mishawaka, Indiana
PHM Schools Gym Floor Replacement
1542.01
270,000.00
Completed 2023
Mishawaka, Indiana
PHM Meadow's Edge
1542.01
580,657.00
In Process
Mishawaka, Indiana
Mishawaka High School Band Room
1542.01
436,600.00
In Process
Mishawaka, Indiana
University of Notre Dame Research Bldg
1542.01
8,574,000.00
In Process
Notre Dame, Indiana
Notre Dame Nieuwland Science Stair
1542.01
559,900.00
In Process
Notre Dame, Indiana
PHM Mary Frank AC Upgrades
1542.01
819,900.00
In Process
Mishawaka, Indiana
Beacon Epworth Crisis Center
1542.01
1,295,558.00
In Process
South Bend, Indiana
Mishawaka Fire Station #2
1542.01
1,320,000.00
In Process
Mishawaka, Indiana
Mishawaka Field House
1542.01
888,822.00
In Process
Mishawka, Indiana
Notre Dame Investment Remodel
1542.01
314,652.00
In Process
Notre Dame, Indiana
Lake Prairie Elementary School
1542.01
1,616,000.00
In Process
Lowell, Indiana
Lakeland CTower
1542.01
440,972.00
In Process
Benton Harbor, Michigan
Walkerton & North Liberty E.S.
1542.01
7,139,600.00
In Process
Walkerton, Indiana
New Buffalo Elementary School
1542.01
1,605,300.00
In Process
New Buffalo, Michigan
Notre Dame DeBartolo Auditoriums
1542.01
754,736.00
In Process
Notre Dame, Indiana
Lowell Middle School Improvements
1542.01
2,248,000.00
In Process
Lowell, Indiana
Corewell Health ICU
1542.01
461,043.00
In Process
Niles, Michigan
South Bend Airport Terminal Upgrades
1542.01
3,057,661.00
In Process
South Bend, Indiana
Beacon Epworth 2nd Floor
1542.01
225,968.00
In Process
South Bend, Indiana
Notre Dame Grace Hall 2nd Floor
Notre Dame, Indiana
Notre Dame O'Shaughnessy Hall
Notre Dame, Indiana
Memorial Hospital Main Lobby
South Bend, Indiana
1542.01
1542.01
1542.01
302,945.00
968,949.00
227,177.00
In Process
In Process
In Process
PRIVATE WORK PERFORMED WITHIN THE PAST FIVE YEARS OVER $150,000.00 IN THE
REQUESTED CATEGORIES.
Six Digit
Name of Private Individual or Firm,
Category
$ Amount
Year
Contact Person, Address, Phone No.
Number
Started/Completed
One National Bank Cascade
1542.02
$207,000
Completed
2019
Grand Rapids, Michigan
Four Winds Casino Players Lounge
1542.02
$920,000
Completed
2019
New Buffalo, Michigan
Four Winds Phase II Test Piles
1542.02
$245,000
Completed
2020
South Bend, Indiana
Four Winds Casino Buffet/Kitchen
1542.02
$1,360,000
Completed
2020
New Buffalo, Michigan
Eddy St Garage Ceilings
1542.02
$374,000
Completed
2020
South Bend, Indiana
Four Winds Casino 3-bay Bathroom
1542.02
$533,000
Completed
2020
New Buffalo, Michigan
Four Winds Timbers Renovation
1542.02
$164,000
Completed
2020
Hartford, Michigan
Strikes and Spares
1542.02
$244,000
Completed
2020
Mishawaka, Indiana
Dr Brandon Zabukovic Buildout
1542.02
$190,000
Completed
2020
South Bend, Indiana
Four Winds Casino Kitchen Floor
1542.02
$165,000
Completed
2021
New Buffalo, Michigan
Four Winds Casino Kankakee
1542.02
$549,000
Completed
2021
New Buffalo, Michigan
Hewlett Dental
1542.02
$170,000
Completed
2021
Mishawaka, Indiana
Labcorp
1542.02
$369,000
Completed
2021
South Bend, Indiana
Four Winds Casino Sports Lounge
1542.02
$254,000
Completed
2021
New Buffalo, Michigan
PRIVATE WORK PERFORMED WITHIN THE PAST FIVE YEARS OVER $150,000.00 IN THE
REQUESTED CATEGORIES.
Six Digit
Name of Private Individual or Firm,
Category
$ Amount
Year
Contact Person, Address, Phone No.
Number
Started/Completed
Pokagon Temporary Housing
1542.02
$279,000
Completed 2021
South Bend, Indiana
Four Winds Casino OTC Expansion
1542.02
$231,000
Completed 2022
South Bend, Indiana
United Way of St Joseph County
1542.02
$593,000
Completed 2022
South Bend, Indiana
Endeavour Construction -Lot 34
1542.02
$234,000
Completed 2022
Elkhart, Indiana
Endeavour Construction -Sanders
1542.02
$157,000
Completed 2022
Elkhart, Indiana
Four Winds Casino T1 Cedar Siding
1542.02
$422,000
Completed 2022
New Buffalo, Michigan
Four Winds Casino HR Offices
1542.02
$251,000
Completed 2022
South Bend, Indiana
Four Winds Casino T2 Finish Upgrades
1542.02
$869,228
Completed 2022
New Buffalo, Michigan
Four Winds Casino T1 Suites
1542.02
$421,488
Completed 2022
New Buffalo, Michigan
Oaklawn Epworth
1542.02
$1,469,796
Completed 2023
South Bend, Indiana
AEP Service Center
1542.02
$1,031,000
In Process
South Bend, Indiana
Four Winds Casino HR Expansion
1542.02
$1,344,183
Completed 2023
New Buffalo, Michigan
SB Specialty Surgery Flooring
1542.02
$229,135
Completed 2023
South Bend, Indiana
Four Winds Player Facility
1542.02
$1,348,000
Completed 2023
South Bend, Indiana
Dick's Sporting Goods
1542.02
$709,368
Completed 2023
Mishawaka, Indiana
PRIVATE WORK PERFORMED WITHIN THE PAST FIVE YEARS OVER $150,000.00 IN THE
REQUESTED CATEGORIES.
Six Digit
Name of Private Individual or Firm, Category $ Amount Year
Contact Person, Address, Phone No. Number Started/Completed
Great River Federal Credit Union 1542.02 $212,980 Completed 2023
Niles, Michigan
Press Ganey Rush Street Renov. 1542.02 $229,135 Completed 2023
South Bend, Indiana
Broadway Christian Parish 1542.02 $202,300 Completed 2023
South Bend, Indiana
Four Winds HR Expansion 1542.02 $977,741 Completed 2023
South Bend, Indiana
INDIANA/KENTUCKY/OHIO REGIONAL COUNCIL OF CARPENTERS
JOINT APPRENTICESHIP AND TRAINING FUND
1565 EAST 70TH COURT
MERRILLVILLE, IN 46410
ADMINISTRATIVE OFFICE
711 Greenwood Springs Drive
Greenwood, IN 46143
Phone:317-807-1112
Fax:317-807-1115
GRAYSON CAMPUS
574 Carpenters Way
Grayson, KY 41143
Phone:606-929-1362
Fax:606-929-5319
INDIANAPOLIS CAMPUS
711 Greenwood Springs Drive
Greenwood, IN 46143
Phone:317-807-1116
Fax:317-807-1131
LAFAYETTE CAMPUS
2953 South Creasy Lane
Lafayette, IN 47905
Phone:765-447-5959
Fax:765-447-7676
LOUISVILLE CAMPUS
1245 Durrett Lane
Louisville, KY 40213
Phone:502-366-8668
Fax:502-366-8678
MERRILLVILLE CAMPUS
1565 East 70'h Court
Merrillville, IN 46410
Phone:219-947-3348
Fax:219-947-1889
MUNCIE CAMPUS
5400 East Centennial Avenue
Muncie, IN 47303
Phone:765-288-9015
Fax:765-288-9298
NEWBURGH CAMPUS
5400 Covert Court
Newburgh, IN 47630
Phone:812-853-9312
Fax:812-853-9316
TERRE HAUTE CAMPUS
3099 S. 61h Street
Terre Haute, IN 47805
Phone:812-466-7899
Fax:812-466-9840
WARSAW CAMPUS
1095 Mariners Drive
Warsaw, IN 46582
Phone: 574-267-5264
Fax: 574-269-1464
May 16, 2024
Gibson Lewis, LLC
1001 W. llch Street
Mishawaka, IN 46544
To Whom It May Concern:
=o.
This letter is in response to verification needed by Gibson Lewis, LLC for work to be
performed on the SBCSC Administration Building Renovation — Elevator
Replacement, owner is City of South Bend, Board of Public Works. Gibson Lewis,
LLC regularly employs a number of apprentices affiliated with our apprenticeship
program and has done so for more than four years. We are registered with the United
States Department of Labor, Bureau of Apprenticeship and Training and our
registration number is IN010520001. Our program participates in the Building Trades
Associate Degree Program with Ivy Tech Community College and has done so since
1996. There have been over 300 apprentices in the last 5 years that have completed the
apprenticeship and advanced to Journeyman.
Gibson Lewis, LLC is a bona fide contractor in good standing with the
Indiana/Kentucky/Ohio Regional Council of Carpenters Joint Apprenticeship and
Training fund and is eligible to employ apprentice carpenters in the future. I have
enclosed a copy of our certificate from the United States Department of Labor.
If I can be of further assistance, please do not hesitate to give me a call,
Sincerely,
f
Chris Charters
Area Training Coordinator
IKORCCJATF — Merrillville, Lafayette & Warsaw Campuses
CC/rlb
INDIANA LABORERS' TRAINING TRUST FUND
David A. Frye
Secretary -Treasurer
Jerry J. Bolk
Chris Brickey
Ricky Henson, Jr.
Ramon Mendoza, Jr.
Brian Short
P.O. Box 758 - Bedford, Indiana 47421
(812)279-9751
March 22, 2024
To Whom It May Concern:
Sean Coakley, Director
John P. Brown
Chairman
Kelly Abel
Michael Ferrara
Stan Meyer
Nick Timmerman
Jim Wiseman
FAX: (812) 279-5545
Toll Free (800) 742-4086
This letter is to confirm that "Gibson -Lewis, LLC" 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 GI educational benefits program, A copy of our approval letters are attached
along with the collective bargaining agreement stating the ratios of Journey workers to
Apprentices; which is one (1) Apprentice for every five (5) Journey workers and thereafter may
not employ more that (1) Apprentice for every (3) Journey workers.
Sincerely,
Sean Coakley,
Director
SC:dc
www.indianalaborerstraining.org
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STATE OF INDIANA
DEPARTMENT OF VETERANS AFFAIRS
STATE APPROVING AGENCY
402 WEST WASHINGTON STREET ROOM W-469
INDIANAPOLIS, INDIANA 46204-2738
Jeremy Brewer
Apprenticeship Coordinator
Indiana Laborers Training Trust Fund -Apprenticeship
439 Patton Hill Rd.
Bedford, IN 47421
Dear Jeremy Brewer,
Eric Holcomb, Governor
James M. Brown, Director
January 9, 2019
The Indiana State Approving Agency conducted a supervisory visit on 01/8/2019 at Indiana
Laborers Training Trust Fund -Apprenticeship. The purpose of the visit was to provide training to
the Certifying Officials and review enrollment certifications, record retention and reporting
procedures.
The organization demonstrated proper record maintenance and record maintenance and reporting
procedures. During the visit, we discussed the importance of reporting hours on a monthly basis,
good record keeping techniques, and how to report a leave of absence or completion via VA Form
22-1999b. We also updated the Certifying Officials via VA Form 22-8794, work processes, and
wage scale.
If you need any assistance or have any questions regarding this technical visit please contact me
directly at tgriffin@dva.in.gov or (317) 232-3916. Thank you for the courtesy extended during my
visit. The education and training opportunities that your organization continues to provide veterans
and their dependents are appreciated.
Sincerely,
Taniqua Griffin
Program Director
Phone (317)-234-6062 Toll Free (800)-400-4520 Fax (317)-234-8744
9
STATE OF I N D IANA
DEPARTMENT OF VETERANS AFFAIRS
STATE APPROVING AGENCY
402 WEST WASHINGTON STREET ROOM W469
INDIANAPOLIS, INDIANA 46204-2738
Jeremy Brewer
Apprenticeship Coordinator
Indiana Laborers Training Trust Fund -Apprenticeship
439 Patton Hill. Rd.
Bedford, IN 47421
Dear Jeremy Brewer,
Eric Holcomb, Governor
James M. Brown, Director
January 9, 2019
This will acknowledge receipt of your updated Wage Scale for the Construction Craft Laborer program
offered by Indiana Laborers Training Trust Fund -Apprenticeship. The State Approving Agency has reviewed
the document as listed below:
Wage Scale: Construction Craft Laborer
FACILITY CODE: 30004114
To the best of my knowledge Indiana Laborers Training Trust Fund -Apprenticeship does not 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 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 content and accuracy. Approval is granted pursuant to the provisions of
Title 38, U.S. Code 3687, with an effective date of April 1, 2018.
If you have any questions, please feel free to give me a call at 317-232-3916 or email me at
tgriffm@dva.in.gov. Thank you for what you do for our Veterans, and have a great day!
Sincerely,
Taniqua Griffin
Program Director
State Approving Agency
Cc: VARO/ELR
-1p,,^
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STATE OF INDIANA
DEPARTMENT OF VETERANS AFFAIRS
STATE APPROVING AGENCY
402 WEST WASHINGTON STREET ROOM W-469
INDIANAPOLIS, INDIANA 46204-2738
Jeremy Brewer
Apprenticeship Coordinator
Indiana Laborers Training Trust Fund -Apprenticeship
439 Patton Hill Rd.
Bedford, IN 47421
Dear Jeremy Brewer,
Eric Holcomb, Governor
James M. Brown, Director
January 9, 2019
This will acknowledge receipt of your 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:
TRAINING PROGRAM LENGTH DOT CODE
Construction Craft Laborer
FACILITY CODE: 30004114
4,000-7800 hours 47-2061.00
To the best of my knowledge Indiana Laborers Training Trust Fund -Apprenticeship does not 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 pursuant to and under the provisions of Title 38, U. S. Code 3687, with an
effective date of January 8, 2019.
If you have any questions, please contact me at 317-232-3916.
Sincerely,
Taniqua Griffin
Program Director
State Approving Agency
Cc:VARO/ELR
Phone (317)-234-6062 Toll Free (800)-400-4520 Fax (317)-234-8744
Apprentice Status Report By Indenture Date
Apprentices Indentured Between 1/1/2018 And 7/1312022
Apprentice Program: IN2
Year Apprentice Status Apprentices Percentage
2018
2019
Active
68
8.05 %
Active Duty
2
0.24 %
Adv. to Journeyman
89
10.53 %
Deceased
5
0.59 %
Graduated
71
8.40 %
Inactive
10
1.18 %
Journeyman
2
0.24 %
Med. Susp.
1
0.12 %
Reinstate
6
0.71 %
Suspended
7
0.83 %
Terminated
546
64.62 %
Voluntary withdraw
38
4.50 %
Total Indentured 845
Active
165
17.65 %
Adv. to Journeyman
72
7.70 %
Deceased
8
0.86 %
Graduated
51
5.45 %
Inacctive
11
1.18 %
Journeyman
12
1.28 %
Med. Susp.
2
0.21 %
Reinstate
15
1.60 %
Suspended
3
0.32 %
Terminated
528
56.47 %
'Voluntary withdraw
68
7.27 %
Total Indentured 935
Printed: Wednesday, July 13. 2022 Page 1 o/ 2
Apprentice Status Report By Indenture Date
Apprentices Indentured Between 1/1/2018 And 7113/2022
Apprentice Program: IN2
Year Apprentice Status Apprentices Percentage
2020
2021
2022
Active
242
36.28 %
Adv. to Journeyman
33
4.95 %
Deceased
2
0.30 %
Graduated
3
0.45 %
Journeyman
1
0.15 %
Med. Susp.
4
0.60
Not Registered
1
0.15 %
Reinstate
12
1.80 %
Suspended
3
0.45 %
Terminated
329
49.33
Voluntary withdraw
37
5.55 %
Total Indentured 667
Active
472
60.90 %
Active Duty
1
0.13 %
Adv. to Journeyman
23
2.97 %
Deceased
2
0.26 %
Med. Susp.
3
0.39 %
Reinstate
20
2.58 %
Suspended
2
0.26 %
Terminated
220
28.39 %
Voluntary withdraw
32
4.13 %
Total Indentured 775
Active
538
86.77 %
Adv. to Journeyman
4
0.65 %
Graduated
1
0.16 %
Med. Susp,
2
0.32 %
Not Registered
5
0.81 %
Reinstate
33
5.32 %
Terminated
32
5.16 %
Voluntary withdraw
5
0.81 %
Total Indentured 620
Printed: Wednesday, Jufy 13, 2022 Page 2 of 2
International Union of Painters and Allied Trades
�-� District Council 91
x 8364 Minnesota Street + Merrillville, IN 46410
DL+91 219-246-4200 4 888-245-1091
b
INDIANA
PLU #47 - Indianapolis
PLU #80 - Lafayette
PLU #156 - Evansville
PLU 0197 - Terre Haute
PLU #460-NW Indiana
PLU #469 - Fort Wayne
PLU #669 - Chesterfield
PLU #1118 - South Bend
KENTUCKY
PLU #118 - Louisville
PLU #5fl0 - Paducah
INDIANA, ILLINOIS
KENTUCKY
Gi U #1165
Evansville -
Fort Wayne
Gary
Indianapolis
South Bend
Vincennes
ter'
•:
Mw
March 22, 2024
Re: Gibson Lewis, LLC
To Whom It May Concern:
Gibson. Lewis, LLC is a local signatory contractor with the International Union of
Painters and Allied Trades, District Council 91, Local #47, and is in good
standing' through the date of this letter.
Sincerely and Fraternally,
Ryan Schweizer
Business Manager/ Secretary -Treasurer
IUPAT DC 91
Plasterers' & Cement Masons'
Apprenticeship Coordinator Local Union #692
To Whom it May Concern:
d y
x
oBVANIR BfJ O
1864 Y
At FS`'a4
Phone: (219) 707-7767
Email: bkristoff@Plcmlocal692.org
March 26, 2024
This letter is to certify that Gibson -Lewis LLC. 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. Gibson -Lewis
LLC. is a valued Contractor in good standing with Local 692 and the JATC. All our
apprentices are registered with the United States Department of Labor.
I may be reached at (219) 707-7767 if additional information is needed.
Further, our organization's program is approved by the U.S. Veterans
Administration to participate in the GI Education Benefit Program.
Thank you,
Brian Kristoff
Apprentice Coordinator
Plasterers & Cement Masons
9200 Louisiana Street • Merrillville, Indiana 46410
WWW.PLCML0CAL692.ORG
GIBSON-LEWIS, LLC
CONTRACTORS
1001 West 11 th Street ♦ Mishawaka, IN 46544 ♦ PO. Box 488 ♦ Mishawaka, IN 46546
(574) 259-8581 ♦ (574) 258-0932 FAX
www.gibson-lewis.com
Drug & Alcohol Free WorkPlace
The Company is committed to the establishment and maintenance of a safe and efficient
work environment for all employees free from the effects of alcohol, illegal drugs, and
other controlled substances and prohibited items.
Section 1. Polic
The Company is committed to providing its employees with a workplace that is safe,
productive and free of substance abuse. The company will take reasonable measures to
insure that employee alcohol or drug use does not jeopardize the safety of other
employees, does not impair their ability to operate efficiently and insures compliance
with drug testing programs mandated by state or federal agencies.
Section 2. Prohibitive Conduct --_Drees
The use, manufacture, distribution, dispensation, sale or possession of illegal drugs at any
time or place, whether on or off duty is strictly prohibited.
Legal Drugs — The use of legal drugs (over the counter or prescription medication) in
accordance with doctor's orders or manufacturer's recommendations, is not prohibited as
long as your Supervisor is notified. Excessive use beyond that prescribed or
recommended or abuse of such drugs, however, shall be considered use of illegal drugs
under this policy.
Section 3. Prohibitive Conduct — Alcohol
The unauthorized use or possession of alcoholic beverages while at the workplace or
performing company business, is prohibited. The term "work place" as used in this
policy includes company premises, jobsites, worksites, parking areas and company
vehicles.
The use of alcohol off premises in any manner which results in intoxication or
impairment on the job or which adversely affects attendance or job performance, is
prohibited.
Appearing for work or performing any job duties or company business while intoxicated
or impaired by alcohol is strictly prohibited.
This may be an abbreviated version of the company's drug and alcohol free work place
policy. Check with your supervisor or person providing the new hire orientation for
further details.
A NATIONAL CONSTRUCTION ENTERPRISES COMPANY
GIBSON-LEW15,LLC CONTRACTORS
1001 West 1-1" Street Mishawaka, IN 46544 .. P.O. Box 488 Mishawaka, IN 46546
r
(574) 259-8581 (574) 258-0932 FAX
To all IUPAT Members Gibson -Lewis Employees,
In order to meet the expectations of the General Contractors, Construction Managers, and
Building Owners, we at Gibson-Lcwis, LLC effective immediately, are implementing
that we will be following the BCRC (Building and Construction Resource Centers)
guidelines for drug testing. BCRC is an Alliance between the labor and the management
representatives for Local union # 460, and now # 1118. Their goal is to assist employers
with establishing and maintaining workplaces that are free from destructive effects
caused when employees use drugs and/or abuse alcohol.
What does this mean as a Gibson -Lewis Employee?
Each and every employee with in the union should have received a letter in January from
the BCRC (Building and Construction Resource Centers) along with a card and an I.D
number. This is your ID card for identifying yourself as the person who received it from
the BCRC. I wi 11 be attaching with this letter a copy of the letter sent to you back in
January, along with the phone number of how to contact the BCRC.
All Gibson -Lewis, LLC employees must have this drag testing procedure finalized by No
Later then, April 17th, 2009. If not completed by this time, employees will be unable to
come into work until the test has been completed.
Where can I take this drug test?
Any Med-Point clinic offers this drug test for the BCRC requirements. Check with
nearest Med-point clinic to set-up an appointment.
We at Gibson -Lewis, LLC want all of our employees to be safe everyday and be able to
work in a safe environment. Each day, our employees, along with you make a difference
to setting standards of being a safe company. By implementing this program, we are not
only taking this next step to being an elite company, we are taking a step towards an
injury free workplace.
Please contact me with any questions, at 574-780-3468
Respectfully,
Brian Shumaker
Safety Director
C;M'..A-- 6- %.A rlk-..- 0---
Building & Construction
Resource Center, Inc.
Phone: (219) 764-9500 - Fax: (219) 764-9505
Toll Free: (877) 988-5400
6050 Southport Rd., Ste. B - Portage, IN 46368
WWW.BCRCNE'T'.com
Tish Roach
Executive Director
'PerspectiveS
(800) 456-6327
www.perspectivesltd.com
Your Employee Assistance Program (EAP)
INDEX
X
PAGE
Introduction . . . . . . . . . . . . . . . . .
. 1
the Policy . . . . . . . . . . . . . . . . . .
. 2
Definitions . . . . . . . . . . . . . . . . . .
. 4
Drug Testing . . . . . . . . . . . . . . . . .
. 20
Drug Group . . . . . . . . . . . . . . . . .
. 22
Alcohol Testing . . . . . . . . . . . . . . . .
. 23
Payment for Testing . . . . . . . . . . . . .
. 24
Initial Testing (Pre -Employment) . . . . . .
. 27
Random Testing . . . . . . . . . . . . . . .
. 27
Vacation Status . . . . . . . . . . . . . . . .
. 28
Owner Requested On -Site Random Testing.
.30
Probable Cause Testing . . . . . . . , . . .
. 31
Post-Accident/Incident Testing . . . . . . .
. 32
Rapid Test Prohibited . . . . . . . . . . . .
. 34
"Emergency" Work Assignments . . . . . .
. 34
Card System . . . . . . . . . . . . . . . . .
. 36
Status Confirmation . . . . . . . . . . . . .
. 36
Reporting of Test Results . . . . . . . . . .
. 37
Insufficient Specimen . . . . . . . . . . . .
. 38
Dilute Specimen . . . . . . . . . . . . . . .
. 38
Adulterated, Substituted, and/or
Out -of -Temperature Specimen . . . . . .
. 39
Consequences for a Non -Negative
or Positive Test . . . . . . . . . . . . . .
. 40
Additional Consequences for Multiple
Non -Compliant Events . . . . . . . . . .
. 42
INDEX
�J:1MV
Observed Return To Duty Testing . . . . . .
. 44
Observed Follow -Up Testing . . . . . . . .
. 45
Disputed Positive Results . . . . . . . . . .
. 46
Appeals and Protections/Just Cause . . . . .
. 47
Illinois — "Drug Free Workplace Act" —
30 ILLS 580 , .. . . . . . . . . . . . .
. 49
Illinois — "Substance Abuse Prevention on Public
Works Projects Act"— 820 ILCS 265 . . .
. 50
Illinois — "Cannabis Regulation and Tax Act" —
410 ILCS 705 . . . . . . . . . . . . . . .
. 51
Indiana — Drug Testing for Public Works —
IND. Code 4-13-18 . . . . ... . . . . .
. 51
Letters of Notice for Random Testing . . . .
.53
Attachment A — General Trades . . . . . . .
. 53
Attachment B — Non -Bargaining . . . . . .
. 54
Attachment C — Pipe Fitters Local #597 . .
. 55
Attachment D — BCRC Authorization to Release
and Disclose Information & Documents . .
. 56
Attachment E — BCRC Application Form
.59
— BCRC Permission Form to
Obtain BCRC Status ...
.60
— BCRC Testing Information
and Instruction Sheet. . . .
. 61
Attachment F — BCRC On -Site Substance
Abuse Testing Addendum . . . . . . . .
. 62
Attachment G — BCRC Drug/Alcohol
Testing Notification . . . . . . . . . . . .
. 63
BUILDING AND CONSTRUCTION
RESOURCE CENTER, INC.
INTRODUCTION
the Labor and Management representatives of the Building
and Construction Industry for Northwest Indiana have formed
an alliance to address the problems caused by drug and alcohol
abuse. Management and Labor together have created the Building
and Construction Resource Center, Inc. (hereafter "BCRC"), an
independent not -for -profit corporation that offers a wide range
of services to Employees in the unionized construction industry,
which includes Employers and Labor Union organizations.
It is BCRC's goal to assist Employers in establishing and
maintaining workplaces that are free of the destructive effects
caused when Employees use or abuse drugs and/or alcohol.
BCRC's activities are not intended to interfere with normal
practices of the Labor Unions or Management. BCRC recognizes
its responsibility to communicate with and educate Employers
and Employees in the unionized construction industry concerning
this policy, as well as the harmful effects of drugs and alcohol in
our society and in the workplace. BCRC also recognizes the need
to provide a program of assistance to those persons for whom
drugs or alcohol may be causing problems. Our Employee
Assistance Program (EAP) provides support, counseling and
resources for life issues that can take a toll on your emotional
well-being or take time away from things you value the most,
like work and family. Finally, while not wishing to violate the
rights or invade the privacy of any Employee, BCRC's drug
testing program will seek to identify those Employees who are
unable or unwilling to conform to BCRC's program.'lhis
program has been established in accordance with the Drug and
Alcohol Testing Industry Association (DATIA), the Substance
Abuse and Mental Health Services Administration (SAMHSA)
and the Federal Department of Transportation Guidelines for
specimen collection, laboratory analysis and review, and standards
of integrity and confidentiality.
1
THE POLICY
Persons who use or abuse drugs and/or alcohol, on or off their
jobs, are likely to be less productive, to be less reliable, to be more
frequently absent and to have other work -related problems that
can cause increased costs, delays, accidents and injuries.
these Employees can also risk the health, safety and well-being
of other workers on the job. The unionized construction industry
can control and reduce this problem through recognition of the
problem, development of a comprehensive policy and program of
education and information, promotion of an Employee Assistance
Program (EAP) and implementation of fair and respectful drug
testing that conforms to the Drug and Alcohol Testing Industry
Association (DATIA), the Substance Abuse and Mental Health
Services Administration (SAMHSA) and the Federal Department
of Transportation Guidelines for specimen collection and analysis.
All of this is to be done with the utmost confidentiality and
respect for the individual.
All Employers (as defined herein) hereby adopt the following
policy:
No Employee may use, possess, distribute, deliver, or be under the
influence of a drug, or use or be under the influence of alcohol,
while performing any work for the Employer.
In order to enhance substance abuse awareness among all
Employers and Employees, educational seminars and training
programs will be offered. The educational seminars will be
directed toward education in regards to the seriousness of the
nationwide drug and alcohol abuse problem and how the use
of drugs and alcohol negatively impacts safety, productivity,
and the competitive ability of the American workforce.
Supervisors will be trained to identify Employees in potentially
difficult situations and to recognize signs of impairment, as well
as the Supervisors'responsibility to document, intervene and
follow-up with the troubled individual. These sessions will be
offered as ongoing training programs.
BCRC, encourages all Employees troubled by their own or a
family member's drug or alcohol abuse to seek professional care
and treatment. Early recognition and treatment of alcohol and
drug abuse provides the greatest opportunity for successful
recovery. BCRC provides an Employee Assistance Program
(EAP) for all Employees and their families who need professional
guidance in assessing their substance abuse or alcohol -related
problem and choosing an appropriate course of treatment.
Current Employees will be referred to an EAP Representative
as a result of a non -negative (positive) drug or alcohol test, a
non -compliant event or upon an individual's own request. In
either case, the content of the discussion with the EAP will be
protected and confidential to the extent allowed by law.
A Participant's use of and communications with the EAP are
confidential and information regarding such confidential matters
will not be released to BCRC or any of its subscribing
organizations or participants without written release from the
participant in accordance with the law. Employees who use the
EAP as a consequence of a non -negative (positive) drug or
alcohol test, or a non -compliant event, will be subject to the
conditions established in the drug testing portion of this policy
and as outlined by the EAP Counselor.
The EAP staff has knowledge of the level and types of benefits
available to BCRC Employees. Employees can access the services
of the EAP through a hotline that is staffed twenty-four (24)
hours a day, seven (7) days a week, throughout the entire year.
Employees calling the EAP hotline are put in touch with a
counselor who will conduct a professional assessment and who
may meet with them to further assess the nature of the problem
in order to provide a referral to the best and most appropriate
level of care.'Ihe EAP is staffed by certified and Masters -level
credentialed human services professionals who are sensitive to
�C�
the needs of the individual. Individuals who take the initiative
to contact the EAP for assistance do so with the assurance that
their calls will be treated respectfully and confidentially. The direct
services provided by the EAP are sponsored by BCRC.
In compliance with Public Law 100-690 (The Drug -Free Workplace
Act), which applies only to Employers who have federal grants
or federal contracts of more than $100,000, an Employee who
is convicted of a workplace drug or alcohol violation and who is
employed by a BCRC affiliated Employer must report this information
to his/her immediate supervisor no later than five (5) days after
such conviction. The Supervisor must report this information
immediately to the Employer's Program Administrator.
DEFINITIONS
• Addendums (i.e., Attachment F) may be approved by
the Board of Directors on an as -needed basis.
Adulterated Specimen means a specimen that has been
altered, as evidenced by test results showing either a
substance that is not a normal constituent for that type
of specimen or showing an abnormal concentration of
an endogenous substance.
Air Blank means, in evidential breath testing devices
(EBTs) using gas chromatography technology, a reading
of the device's internal standard. In all other EBTs, a
reading of ambient air containing no alcohol.
• Alcohol means the intoxicating agent in beverage
alcohol, ethyl alcohol, or other low molecular weight
alcohols including methyl and isopropyl alcohol.
■ Alcohol Concentration or content means the alcohol
in a volume of breath expressed in terms of grams of
alcohol per 210 liters of breath as indicated by an
evidential breath test under this policy (BrAC).
0
• Alcohol Confirmation Test means a subsequent test
using an EBT, following a screening test with a result of
0.02 or greater, which provides quantitative data about
the alcohol concentration.
Alcohol Screening Device LASDi a breath or saliva
device, other than an EBT, that is approved by the
National Highway Traffic Safety Administration
(NHTSA) and appears on the Office of Drug and
Alcohol Policy and Compliance (ODAPC) web page
for "Approved Screening Devices to Measure Alcohol
in Bodily Fluids" because it conforms to the model
specifications from NHTSA.
• Alcohol Screenin Test means an analytic procedure to
determine whether an employee may have a prohibited
concentration of alcohol in a breath specimen.
Alcohol Testing Site a place selected by the Employer
where employees present themselves for the purpose of
providing breath or saliva for an alcohol test.
• Alcohol Use means the drinking or swallowing of any
beverage, liquid mixture or preparation (including any
medication), containing alcohol.
• Aliquot means a fractional part of a specimen used for
testing. It is taken as a sample representing the whole
specimen.
• Aov_, licant means a person, Independent Contractor,
or Employer, or person working for an Independent
Contractor, or Employer who applies to become an
Employee of a BCRC Contractor/Employer Participant,
and includes a person who has received a job offer made
contingent on the person passing a drug test.
5
• Archived Status means the status of a person who has
been inactive, deactivated, working outside of the
geographic area covered by BCRC or otherwise taken
out of the BCRC random pool.
Authorized Test means a drug and/or alcohol test
performed in accordance with the provisions of this
Policy and at the request (or direction) of BCRC.
BCRC means Building and Construction Resource
Center, Inc., which is a not -for -profit corporation
formed by labor and management representatives of
the building and construction industry for Indiana &
Illinois, for the purpose of addressing problems of drugs
and alcohol in the workplace.
BCRC Poliev means all of the policies, procedures, and
other matters set forth in this document (i.e., the BCRC
Drug & Alcohol Policy) and all amendments and
addenda to this document.
Breath Alcohol Technician (BAT) is a person who
instructs and assists employees in the alcohol testing
process and operates an Evidential Breath Testing
device (EBT).
Canceled Test means a drug or alcohol test that has a
problem identified that cannot be or has not been
corrected. A canceled test is neither a positive nor a
negative test. An Employer is not permitted to take
adverse job action based on a canceled test.
Card Manager is the individual designated by each
Employer who has the authority to access data
information that will confirm the status of Employees
by electronic mail.
0
• CL or Clear means that an Employee is "cleared",
available for work, and currently compliant with this
Policy when used with respect to the BCRC status of
an Employee.
Chain of Custody the procedure used to document the
handling of the urine specimen from the time the
employee gives the specimen to the collector until the
specimen is destroyed. Ibis procedure uses the Federal
Drug Testing Custody and Control Form (CCF) as
approved by the Office of Management and Budget.
■ Collection Container means a container into which
the Employee urinates to provide the specimen for a
drug test.
Collection Site means a place designated by BCRC
where individuals present themselves for the purpose of
providing a specimen to be analyzed for the presence of
controlled substances or for purposes of providing a
breath sample to be analyzed for alcohol concentration.
Collector means a person who instructs and assists
Employees at a collection site, who receives and makes
an initial inspection of the specimen provided by those
employees, and who initiates and completes necessary
forms.
• Company means an Employer/Contractor who is a
member of BCRC.
Confirmation (or confirmatory) DrugTest a second
analytical procedure performed on a different aliquot of
the original specimen to identify and quantify the
presence of a specific drug or drug metabolite.
7
• Confirmation for confirmatory) ValidityTest a second
test performed on a different aliquot of the original
urine specimen to further support a validity test result.
• Confirmed DrugTests a confirmation test result
received by an MRO from a laboratory.
• Confirmatory Test
a) For alcohol testing, a confirmatory test is a second
test following a screening test with a result of 0.02
or greater, conducted 15-30 minutes later, that
provides quantitative data of alcohol concentration.
this test is conducted on an Evidential Breath
Testing Device (EBT).
b) For controlled substances testing, a confirmatory
test is a second analytical procedure on the same
specimen to identify the quantitation and
presence of a specific drug or metabolite. This
confirmatory test is independent of the initial test
and uses a different technique and chemical
principle from that of the screening test in order
to ensure reliability and accuracy. Gas
Chromatography/Mass Spectrometry (GC/MS)
is the only authorized confirmation method for
cocaine, marijuana, synthetic opiates, opioids,
amphetamines and phencyclidine.
• Contractor Participant means an Employer who is a
contributing member of BCRC.
Controlled Substance means marijuana (THC),
cocaine, synthetic opiates, opioids, oxycodones,
MDA-analogues, phencyclidine (PCP), amphetamines
(including methamphetamines), methaqualone,
barbiturates, benzodiazepine, propoxyphene, methadone,
6-acetymorphine and ecstasy.
0
Designated Employer Representative (DER) an
Employee authorized by the Employer to take immediate
action(s) to remove Employees from safety -sensitive duties
or cause Employees to be removed from these covered
duties and to make required decisions in the testing and
evaluation processes. The DER also receives test results
and other communications for the Employer consistent
with the requirements of this policy. Service agents
cannot act as DERs.
• Dilute Specimen means a specimen with creatinine
and specific gravity values that are not consistent with
medical expectations for human urine.
DOT these terms encompass all DOT agencies,
including, but not limited to, the Federal Aviation
Administration (FAA), the Federal Railroad
Administration (FRA), the Federal Motor Carrier
Safety Administration (FMCSA), the Federal Transit
Administration (FTA), the National Highway Traffic
Safety Administration (NHTSA), the Pipeline and
Hazardous Materials Safety Administration (PHMSA),
and the Office of the Secretary (OST). For purposes of
this part, the United States Coast Guard (USCG) in the
Department of Homeland Security is considered to be
a DOT agency for drug testing purposes only since the
USCG regulation does not incorporate Part 40 for its
alcohol testing program. These terms include any
designee of a DOT agency.
Drugs mean the substances for which tests are required
under this policy and include marijuana (THC), cocaine,
amphetamines (including methamphetamines),
methaqualone, phencyclidine (PCP), opioids, synthetic
opiates, oxycodones, MDA-analogues, barbiturates,
benzodiazepine, propoxyphene, methadone,
6-acetymorphine and ecstasy.
�t,
■ DrugTest means a test conducted for controlled
substances.
• Employee means an Employee of a Company, or of a
Contractor/Employer Participant, who is a member
of BCRC.
Employee Assistance Program (EAP) Counselor
means a Masters -level professional with an education in
psychology, social work, counseling, etc. with knowledge
of and clinical experience in diagnosis and treatment
of alcohol and controlled substance related disorders.
The EAP will assess and make recommendations
concerning education, treatment, Observed Follow -Up
Testing and aftercare.
• 'Employer means a Company, or a Contractor/Employer
Participant, who is a member of BCRC.
Evidential Breath Tcsting Device EBT means a
device approved by NHTSA for the evidential testing of
breath at the .02 and .04 alcohol concentrations, placed
on NHTSAs Conforming Products List (CPL) for
"Evidential Breath Measurement Devices" and identified
on the CPL as conforming with the model specifications
available from NHTSA's Traffic Safety Program.
First Occurrence Clause means if an Employee does
not report for a random test, and it is the first time the
Employee has failed to report, the'lhird Party
Administrator (TPA or BCRC} may allow the
Employee to take the test without reporting to the
EAP for further review. Employees may utilize this
clause only one time.
Gas Chromiltogranhr/Mass Speetrometry
Confirmation (GC/MS) is a state-of-the-art drug
testing technology, providing a fingerprint of the
detected drug.
10
• HHS means the Department of Health and Human
Services or any designee of the Secretary, Department
of Health and Human Services.
HHS-�1u raved Laborato v any U.S. laboratory
certified by HHS under the National Laboratory
Certification Program as meeting the minimum
standards of Subpart C of the HHS Mandatory
Guidelines for Federal Workplace Drug Testing
Programs; or, in the case of foreign laboratories, a
laboratory approved for participation by DOT under
this part.
Initial Test (for drugs) means an immunoassay screen
to eliminate negative urine specimens from further
consideration.
Initial Validity Icst means the first test used to
determine if a specimen is adulterated, diluted or
substituted.
Invalid Drua est the result reported by an HHS
certified laboratory in accordance with the criteria
established by HHS Mandatory Guidelines when a
positive, negative, adulterated or substituted result
cannot be established for a specific drug or specimen
validity test.
Laboratory any U.S. laboratory certified by HHS
under the National Laboratory Certification Program as
meeting the minimum standards of Subpart C of the
HHS Mandatory Guidelines for Federal Workplace
Drug Testing Programs; or, in the case of foreign
laboratories, a laboratory approved for participation by
DOT under this part.
11
Licensed Medical Practitioner means a person who is
licensed, certified, and/or registered, in accordance with
applicable Federal, State, Local, or Foreign laws and
regulations to prescribe controlled substances and
other drugs.
Medical Review Officer (MRO means a Licensed
Physician, registered with the American Association
of Medical Review Officers (www.aamroxom),
responsible for receiving laboratory results generated by
BCRC's drug testing program who has knowledge of
substance abuse disorders and who has appropriate
medical training to interpret and evaluate an
individual's confirmed positive test result together with
his/her medical history and any other relevant
biomedical information.
N/A or Not Available means that an Employee is not
available for work and is not currently compliant with
this Policy when used with respect to the BCRC status
of an Employee. (NOTE: An Employee can be N/A
for several reasons, which may or may not include failing
a drug or alcohol test).
New P�ee/Applicant means a person who has not
been previously tested by BCRC and includes a person
referred for pre -employment testing.
Non -Compliant Event means any of the following:
(a) a Positive Test for alcohol or drugs (which shall also
include any Positive Tests that occur during any
retesting), (b) an -Insufficient Specimen if an appropriate
medical professional determines that there is no
legitimate medical reason for the Insufficient Specimen,
(c) a negative Dilute Specimen if the Employee fails
to provide a second (2nd) testing sample within the
applicable time period specified in this BCRC Policy
12
or a second (2nd) testing sample that is also a negative
Dilute Specimen [provided, however, that a second (2nd)
negative Dilute Specimen shall not constitute a
Non -Compliant Event if. (1) the MRO determines
that there is a valid medical reason for the second (2nd)
Dilute Specimen, or (2) such treatment is prohibited by
applicable law], (d) an Adulterated Specimen, (e) a
Substituted Specimen, (f) an Out -of -Temperature
Specimen, (g) any acts by an Employee that compromise
the testing protocol (i.e., washes his/her hands, flushes
the toilet, etc.) prior to being given direction from the
collection professional, (h) a Refusal To Submit (to an
alcohol or controlled substances test), (i) a failure to
submit to Post-Accident/Incident Testing (which shall
include a failure to test resulting from the Employee
leaving the jobsite prior to such Post-Accident/Incident
Testing), and 0) any other act or omission by an
Employee that BCRC determines, in BCRC's sole
discretion, to constitute a substantial or willful
non-compliance with the policies and/or procedures set
forth in this Policy. A Non -Compliant Event is also
commonly referred to as a "strike."
Non-Ngggfive means a urine specimen that is reported
as an Adulterated Specimen, a Substituted Specimen, a
Positive Test [for drug(s) or drug metabolite(s)], a
Non -Compliant Event and/or invalid.
Observed Follow -Up Testing shall be required, based
on an EAP evaluation for a Non -Negative or Positive
Test result, missed random, incomplete test/walk outs
and as provided in this BCRC Policy. All Follow -Up
Testing will be administered by the TPA (BCRC) and
must be observed.
Observed Return To DutvTest or Observed RTD Test
is an observed test required by this BCRC Policy that
13
must be taken before an Employee can be returned to
"clear" status. Such test is scheduled by the counselor at
such time as the counselor deems appropriate after the
EAP evaluation has been completed. This BCRC Policy
requires such test following a Non -Negative test, missed
random, walkout, Refuse to Submit as described in the
BCRC Policy, or other Non -Compliant Event. If the
test is not taken as directed by the EAP, the Employee
will be required to return to the EAP.
• Out -of -Temperature Specimen means a specimen
that is below 90°F or above 100OF at the time the
specimen is obtained at the collection site.
• Owner means a business or other entity (or individual)
that hires a "Contractor Participant" to perform work at
their facility, office, and/or property.
Owner Requested Job -Site Random Tcs ft means a
Northwest Indiana Business Roundtable Owner, which
has been approved by the Board of Directors, and may
require a random drug test be done at their facility.
The Employee will test within one hour of notification
of the random test. The test may be performed at the
Owner's facility no more than monthly provided there is
an approved BCRC Collection Site at the facility.
• Positive Test (alcohol) occurs when an Employee's
confirmatory test result reads 0.02 BrAC or higher.
Positive' est {_drugs3 occurs when an HHS-certified
laboratory reports a drug test as positive because a
specimen contains a drug or drug metabolite equal to or
greater than the cutoff concentrations.
■ Post-Accident/Incident Testing means drug and
alcohol tests requested by an Employer following the
occurrence of an accident and/or incident.
14
• Probable CauseTesng maybe required when a
Supervisor observes and documents unusual behavior.
Program Administrator means the individual who has
administrative responsibilities for overseeing the drug
and alcohol testing program for an Employer.
The Program Administrator may serve as an
Employer's DER.
Pro a means all Employer -owned and/or leased
property, including but not limited to owned and/or
leased buildings and other real estate, parking lots and
vehicles located on parking lots, and Employer -owned
and/or leased vehicles, lockers, tools, equipment and
desks.
Random Selection means a scientifically valid method
for selection of Employees to be tested that result in an
equal probability that any Employee from a group of
Employees subject to the selection mechanism will be
selected, and does not give an Employer discretion to
waive the selection of any Employee under the
mechanism.
• Refuse To Submit to an alcohol or controlled
substances test
Means that an Employee:
1. Fails(ed) to appear for any test (except a
pre -employment test) within a reasonable time, as
determined by the BCRC Policy, after being directed
to do so by the BCRC Policy;
2. Fails(ed) to remain at the testing site until the testing
process is complete (a walk out);
15
3. Fails(ed) to provide a urine specimen for any drug
test required by this BCRC Policy;
4. In the case of a directly observed or monitored
collection in a drug test, fails to permit the
observation or monitoring of the Employee's
provision of a specimen;
5. Fails(ed) to provide a sufficient amount of urine
when directed, and it has been determined, through
a required medical evaluation, that there was no
acceptable medical explanation for the failure;
6. Fails(ed) or declines to take a second test the Employer
or collector has directed the Employee to take;
7. Fails(ed) to undergo a medical examination or
evaluation, as directed by the MRO as part of the
verification process, or as directed by the policy.
In the case of a pre -employment drug test, the
Employee is deemed to have refused to test on this
basis only if the pre -employment test is conducted
following a contingent offer of employment;
8. Fails(ed) to cooperate with any part of the testing
process (e.g., refuse to empty pockets when so
directed by the collector, behaves in a confrontational
way that disrupts the collection process, provides
incorrect or inaccurate information to the collection
site or on necessary forms, or fails to complete all
documents);
9. Provides a second (2nd) specimen that is dilute.
Reinstatement Test is the test allowed by BCRC, which
must be consistent with the Policy, to reactivate an
Employee who has been on "Vacation" or "Archived
16
Status" for twelve (12) months or more and has not
tested under the BCRC Policy in the past twelve (12)
months.
■ Rejected For Testing the result reported by an
HHS-certified laboratory when no tests are performed
for a specimen because of a fatal flaw or a correctable
flaw that is not corrected.
Itcporting Employee is an Employee who reports a
work -related injury or illness that was caused by and/
or relates to the accident and/or incident for which the
post-accident/incident drug or alcohol testing is
requested by the Employer.
Safc Site means a URL beginning with "https"which is
a secure site for data transmission.
SAMHSA means Substance Abuse and Metal Health
Services Administration is the agency within the U.S.
Department of Health and Human Services that leads
public health efforts to advance the behavioral health
of the nation.
• ScreeningTest (or initial test):
• In drug testing, a test to eliminate "negative" urine
specimens from further analysis or to identify a
specimen that requires additional testing for the
presence of drugs.
• In alcohol testing, an analytical procedure to determine
whether an employee may have a prohibited
concentration of alcohol in a breath specimen.
17
Screening Test Technician f STT means a person who
instructs and assists employees in the alcohol testing
process and operates an Alcohol Screening Device
(ASD).
• Shipping Container means a container that is used for
transporting and protecting urine specimen bottles and
associated documents from the collection site to the
laboratory.
• Specimen means a sample of urine, used for analysis
and/or diagnosis. For the purpose of this policy;
specimen is defined as urine.
Specimen Bottle means the bottle that, after being
sealed and labeled according to the procedures in this
policy, is used to hold the urine specimen during
transportation to the laboratory.
Split Specimen means a part of the urine specimen that
is sent to a first laboratory and retained unopened, and
which is transported to a second laboratory in the event
that the Employee requests that it be tested following a
verified positive test of the primary specimen or a
verified adulterated or substituted test result.
Substituted Speck means a specimen with
creatinine and specific gravity values that are so
diminished that they are not consistent with human
urine.
• Testing Levels means levels at or above when a
specimen is determined to be positive, and below when
a specimen is determined to be negative.
Third PaM Administrator (TPA)means an entity that
provides or coordinates one or more drug and/or alcohol
testing services to Employers. A TPA typically provides
or coordinates the provision of a number of such services
and performs administrative tasks concerning the
operation of drug and alcohol testing programs for
Employers. This term includes, but is not limited to,
groups of Employers who join together to administer,
as a single entity, the drug and alcohol testing programs
of its Employees (e.g., having a combined random
testing pool).
• Traveler means a craft person who: (a) is coming to
work in the geographic area covered by BCRC, and
(b) is a member of local union whose jurisdiction is
outside of the geographic area covered by BCRC.
Unauthorized Test means a drug and/or alcohol test
that is: (a) not performed in accordance with the
provisions of this Policy, and/or (b) not performed at the
request (or direction) of BCRC. Such tests include
retests initiated by an Employer and/or an Employee
that are not performed at the request (or direction) of
BCRC.
Union means a Labor Organization that represents
Employee(s) who are employed by a Company, or of a
Contractor/Employer participant, who is a member of
Building and Construction Resource Center, Inc.
Vacation Stattis means the status of an Employee who
is temporarily removed from the BCRC random pool
while on vacation or a non -work related absence.
• Verified Test means a drug test result or validity testing
result from a HHS-certifies l laboratory that has
undergone review and final determination by the MRO.
19