HomeMy WebLinkAboutOpening of Quotes - Sewer Repair-Bendix & Westmoor Intersection Proj No. 124-045 - Selge ConstructionCITY OF SOUTH BEND, INDIANA
CONTRACTOR'S QUOTE -FOR PUBLIC WORK
PROJECT NAME:
PROJECT NO.
QUOTES DUE
Sewer Repair — Bendix and Westmoor Intersection
124-045
July 9, 2024
(Must be completed for all quotes. Please type or print)
Date: July 9, 2024 Firm: Selge Construction Co., Inc.
Address:
City/State/Zip
2833 South 11 th Street
Niles, MI 49120 Telephone Number: 2( 69 ) 684-0842
Email Address: jbutler@sel econstruction.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:
Sewer Repair - Bendix and Westmoor Intersection #124-045
the City of South Bend, Indiana, in accordance with plans and specifications prepared by:
The City of South Bend, Department of Public Works
and dated July 9, 2024 for the sum of (enter the Total Quote as shown on the Proposal)
Two Hundred Three Thousand Five Hundred Twenty Dollars and Zero Cents ($ 203,520.00
(Enter Sum of Total Quote plus Alternates shown on Proposal) (Numerical)
If alternative quotes apply, the undersigned submits a proposal for each in accordance with the notice. Any
addendums attached will be specifically referenced on the applicable page.
If additional units of material included in the contract are needed, the cost of units must be the same as that shown
in the original contract if accepted by the City of South Bend. If the quote is to be awarded on a unit basis, the
itemization of the units shall be shown on a separate attachment.
By '
(Signature)
Ju Butler, Vice President
(Printed Name of Person Signing)
ACCEPTANCE
The above quote is accepted this day of 20
Subject to the following conditions:
BOARD OF PUBLIC WORKS
Elizabeth A. Maradik, President Joseph R. Molnar, Vice President
Gary A. Gilot, Member Breana N. Micou, Member
Murray L. Miller, Member Attest: Theresa Heffner, Clerk
Version 3/15/2024 Page - 9 Public Works Quote
r 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 Michigan )
) SS:
Berrien 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. Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of
Version 3/15/2024 Page - 10 Public Works Quote
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 employment, or any matter
directly or indirectly related to employment because of race, sex, religion, color, national origin,
ancestry, age, gender expression, gender identity, sexual orientation 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. 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). 1 hereby certify that I and all subcontractors employed by me for this project will use steel
products or foundry products made in the United States on this project if awarded. I understand I
Version 3/15/2024 Page - 11 Public Works Quote
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 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 9th day of J u lY , 2024
Subscribed and sworn to before me this 9th
My Commission Expires 10/27/2027
County of Residence
Selge Construction Co., Inc.
ContractorBidder (Firm)
Sin lure of ContractorBidder or Its Agent
Justin Butler, Vice President
Printed Name and Title
jdo.,July 2024
)in(, Lf,4
otary Public
'.d1i V[i� aP7lif0fl►.
Berrien
r
1 �1
'•• MI C1 t� .••
Version 3/15/2024 Page - 12 Public Works Quote
PROJECT NAME
PROJECT NO.
QUOTES DUE
D A C U f 1 i 1 n-r A TT ni.T
1S 11
� �Y1
dl
QUOTE/PROPOSAL n-ACL J
CITY OF SOUTH BEND;,,)
Sewer Repair — Bendix and Westmoor Intersection
124-046
July 9, 2024
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
1
Mobilization and Demobilization
1
LS
$ 38,750.00
$ 38,750.00
2
Excavation, Common
140
CYS
$ 25.00
$ 3,500.00
3
Pipe, Sanitary Sewer, Reinforced Concrete, 18-
20
LFT
$ 1,105.00
$ 22,100.00
IN
Aggregate No. 53, 6-IN Depth
SYS
$ 8,820.00
4
280
$ 31.50
5
Manhole, Eccentric Cone Riser Section, 60-IN
1
EACH
$ 35,750.00
$ 35,750.00
Diameter
6
Pre -Cast or Cast -In -Place (Circle One)
Stabilization Ring at Brick Manhole Interface
1
EACH
$ g 500.00
$ 8,500.00
7
Casting and Solid Lid, Furnish and Adjust to
1
EACH
Grade
$ 2,500.00
$ 2,500.00
8 Temporary Bypass Pumping
1
LS
$ 21,000.00
$ 21,000.00
9
Watermain, Ductile Iron Pipe, Class 50, 6-IN
40
LFT
$ 400.00
$ 16,000.00
Knife Gate Valve, Ductile Iron, 6-IN
1
EACH
$4,600.00
10
$ 4,600.00
Total Amount of Quote
$161,520.00
ALTERNATE NO
Item
No.
Description
f
Quantity
Unit
Unit Price
Total Amount
1
HMA Pavement Patching, 12-inch
280
SYS
$ 150.00
$42,000.00
Total Amount Alternate No. 1
$ 42,000.00
Firm. Selge Construction Co., Inc.
Address: 2833 South 11th Street
City/State/Zip
Niles, MI 49120 Telephone Number: 2( 69 ) 684-0842
Fax Number: (269 -) 684-0846
Version 3/15/2024 Page - 13 Public Works Quote
By
(Signature)
Justin Butler, Vice President
(Printed Name of Person Signing)
Version 3/15/2024 Page - 14 Public Works Quote
BID BOND (PENAL SUM FORM)
Bidder
Name: Selge Construction Co., Inc.
Address (principal place of business):
2833 South 11 th Street
Niles, MI 49120
Owner
Name: City of South Bend Board of Public Works
Address (principal place of business):
227 West Jefferson Boulevard
South Bend, IN 46601
Surety
Name: The Cincinnati Insurance Company
Address (principal place of business):
P.O. Box 145496
Cincinnati, OH 45250-5496
Bid
Project (name and location):
Project No. 124-045 Westmoor and Bendix
Intersection — Sewer Repair
Bid Due Date: July 9, 2024
Bond
Penal Sum: $5,000.00 Five Thousand Dollars and 00/100
Date of Bond: July 9, 2024
Surety and Bidder, intending to be legally bound hereby, subject to the terms set forth in this Bid Bond,
do each cause this Bid Bond to be duly executed by an authorized officer, agent, or representative.
Bidder Surety
Seel a Construction Co., Inc. The Cincinnati Insurance Com an
(Full f r al n e nf�idder) (Fu!!fargrrof name of Surety) (corporate sea (;€ com
/ I Af ��I . I 1 S E
By:
CZ (Signature)
Name: Justin Butler
(Printed or typed)
Title: iceCPresid
Attest: ? f �.
- (Signature)
Name: Allison Swinehart
(Printed or typed)
By:
(Signature) (Attach Power of.
Name: Tracie House
(Printed or typed)
Title: Att me -in-F ct
Attest:
(Signature)
Name: Tracey Heiss
(Printed or typed)
Title: Corp. Secretary Title: Witness
Notes: (1) Note: Addresses are to be used for giving any required notice. (2) Provide execution by any additional parties, such as
joint venturers, if necessary.
EJCDC® C-430, Bid Bond (Penal Sum Form). (EA-02/21)
Copyright° 2018 National Society of Professional Engineers, American Council of Engineering Companies,
and American Society of Civil Engineers. All rights reserved.
Page i of 2
1. Bidder and Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors,
and assigns to pay to Owner upon default of Bidder the penal sum set forth on the face of this Bond.
Payment of the penal sum is the extent of Bidder's and Surety's liability. Recovery of such penal sum under
the terms of this Bond will be Owner's sole and exclusive remedy upon default of Bidder.
2. Default of Bidder occurs upon the failure of Bidder to deliver within the time required by the Bidding
Documents (or any extension thereof agreed to in writing by Owner) the executed Agreement required by
the Bidding Documents and any performance and payment bonds required by the Bidding Documents.
3. This obligation will be null and void if:
3.1. Owner accepts Bidder's Bid and Bidder delivers within the time required by the Bidding Documents
(or any extension thereof agreed to in writing by Owner) the executed Agreement required by the
Bidding Documents and any performance and payment bonds required by the Bidding Documents, or
3.2. All Bids are rejected by Owner, or
3.3. Owner fails to issue a Notice of Award to Bidder within the time specified in the Bidding Documents
(or any extension thereof agreed to in writing by Bidder and, if applicable, consented to by Surety
when required by Paragraph 5 hereof).
4. Payment under this Bond will be due and payable upon default of Bidder and within 30 calendar days after
receipt by Bidder and Surety of written notice of default from Owner, which notice will be given with
reasonable promptness, identifying this Bond and the Project and including a statement of the amount
due.
5. Surety waives notice of any and all defenses based on or arising out of any time extension to issue Notice
of Award agreed to in writing by Owner and Bidder, provided thatthe total time for issuing Notice of Award
including extensions does not in the aggregate exceed 120 days from the Bid due date without Surety's
written consent.
6. No suit or action will be commenced under this Bond prior to 30 calendar days after the notice of default
required in Paragraph 4 above is received by Bidder and Surety, and in no case later than one year after
the Bid due date.
7. Any suit or action under this Bond will be commenced only in a court of competent jurisdiction located in
the state in which the Project is located.
8. Notices required hereunder must be in writing and sent to Bidder and Surety at their respective addresses
shown on the face of this Bond. Such notices may be sent by personal delivery, commercial courier, or by
United States Postal Service registered or certified mail, return receipt requested, postage pre -paid, and
will be deemed to be effective upon receipt by the party concerned.
9. Surety shall cause to be attached to this Bond a current and effective Power of Attorney evidencing the
authority of the officer, agent, or representative who executed this Bond on behalf of Surety to execute,
seal, and deliver such Bond and bind the Surety thereby.
10. This Bond is intended to conform to all applicable statutory requirements. Any applicable requirement of
any applicable statute that has been omitted from this Bond will be deemed to be included herein as if set
forth at length. If any provision of this Bond conflicts with any applicable statute, then the provision of said
statute governs and the remainder of this Bond that is not in conflict therewith continues in full force and
effect.
11. The term "Bid" as used herein includes a Bid, offer, or proposal as applicable.
EJCDC° C-430, Bid Bond (Penal Sum Form). (EA-02/21)
Copyright® 2018 National Society of Professional Engineers, American Council of Engineering Companies,
and American Society of Civil Engineers. All rights reserved.
Page 2 of 2
THE CINCINNATI INSURANCE COMPANY
THE CINCINNATI CASUALTY COMPANY
Fairfield, Ohio
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That THE CINCINNATI INSURANCE COMPANY and THE CINCINNATI CASUALTY
COMPANY, corporations organized under the laws of the State of Ohio, and having their principal offices in the City of Fairfield,
Ohio (herein collectively called the "Companies"), do hereby constitute and appoint Tracie House
its true and legal Attorney -in -Fact to sign and deliver on behalf of the Companies as Surety, at any place within the United States,
the following surety bond:
Surety Bond Number: Bid Bond
Principal: Selge Construction Co., Inc.
Obligee: City of South Bend Board of Public Works
This appointment is made under and by authority of the following resolutions adopted by the Boards of Directors of The Cincinnati
Insurance Company and The Cincinnati Casualty Company, which resolutions are now in full force and effect, reading as follows:
RESOLVED, that the President or any Senior Vice President be hereby authorized, and empowered to appoint Attorneys -in -Fact
of the Company to execute any and all bonds, policies, undertakings, or other like instruments on behalf of the Corporation, and
may authorize any officer or any such Attorney -in -Fact to affix the corporate seal; and may with or without cause modify or
revoke any such appointment or authority. Any such writings so executed by such Attorneys -in -Fact shall be binding upon the
Company as if they had been duly executed and acknowledged by the regularly elected officers of the Company.
RESOLVED, that the signature of the President or any Senior Vice President and the seal of the Company may be affixed by
facsimile on any power of attorney granted, and the signature of the Secretary or Assistant Vice -President and the Seal of the
Company may be affixed by facsimile to any certificate of any such power and any such power of certificate bearing such
facsimile signature and seal shall be valid and binding on the Company. Any such power so executed and sealed and certified
by certificate so executed and sealed shall, with respect to any bond or undertaking to which it is attached, continue to be valid
and binding on the Company.
IN WITNESS WHEREOF, the Companies have caused these presents to be sealed with their corporate seals, duly attested by their
President or any Senior Vice President this 16th day of March, 2021.
e
e
STATE OF OHIO )SS:
COUNTY OF BUTLER )
THE CINCINNATI INSURANCE COMPANY
THE CINCINNATI CASUALTY COMPANY
On this 16th day of March, 2021 before me came the above -named President or Senior Vice President of The Cincinnati Insurance
Company and The Cincinnati Casualty Company, to me personally known to be the officer described herein, and acknowledged that the
seals affixed to the preceding instrument are the corporate seals of said Companies and the corporate seals and the signature of the
officer were duly affixed and subscribed to said instrument by the authority and direction of said corporations.
Keith Cott, Attorney at Law
Notary Public — State of Ohio
My commission has no expiration date.
Section 147.03 O.R.C.
I, the undersigned Secretary or Assistant Vice -President of The Cincinnati Insurance Company and The Cincinnati Casualty Company,
hereby certify that the above is the Original Power of Attorney issued by said Companies, and do hereby further certify that the said
Power of Attorney is still in full force and effect.
Given under my hand and seal of said Companies at Fairfield, Ohio, this 9th day of July 12024 .
�p � R L � F SORPORAIE S
-SEAL
CN1� nili�
BN-1457-S (3/21)
CITY OF SOUTH BEND TAMES MUELLER, MAYOR
DEPARTMENT OF PUBLIC WORKS
ERIC HORVATH, DmECTOR
December 14, 2023
Allison Swinehart
Selge Construction Company
aswinehart@selgeconstruction.com
RE: Pre -Qualification Verification
Dear Ms. Swinehart:
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,
Tara Bussell, Permit Manager
STATE OF INDIANA
OFFICE OF THE SECRETARY OF STATE
CERTIFICATE OF AUTHORIZATION
To Whom These Presents Come, Greetings:
I, TODD ROKITA, Secretary of State of Indiana, do hereby certify that I am, by virtue of the laws of the State of Indiana,
the custodian of the corporate records, and proper official to execute this certificate.
I further certify that records of this office disclose that
SELGE CONSTRUCTION CO INC
duly filed the requisite documents to commence business activities under the laws of State of Indiana on March 15, 1972, and
was in existence or authorized to transact business in the State of Indiana on February 10, 2010.
I further certify this For -Profit Foreign Corporation has filed its most recent report required by Indiana law with the Secretary
of State, or is not yet required to file such report, and that no notice of withdrawal, dissolution or expiration has been filed or
taken place.
In Witness Whereof, I have hereunto set my hand
and affixed the seal of the State of Indiana, at the
city of Indianapolis, this Tenth Day of February, 2010.
ram^
TODD ROKITA, Secretary of State
197203-307 / 2010021072953
CONSENT RESOLUTIONS OF THE SHAREHOLDERS AND DIRECTORS
OF SELGE CONSTRUCTION CO., INC.
The Shareholders and Board of Directors of Selge Construction Co., Inc., a Michigan
corporation, take the following actions pursuant to Section 407 and Section 525 of the
Michigan Business Corporation Act:
Financial Statement
The financial statements have been reviewed by all shareholders and officers and
approved as presented.
2. Board of Directors
The following persons were elected to serve as directors of the Corporation until
the next annual shareholders meeting or until their successors are elected and take
office:
Marvin L. Selge, Jr.
3. Officers
The following person shall hold the offices set forth opposite their names until
their successors are elected and shall qualify:
Name
James Boyles
Justin E. Butler
Allison Swinehart
Marvin L. Selge, Jr.
Office
President
Vice President
Secretary
Treasurer
4. Authorization to Sign Construction Documents
The President, James Boyles, the Vice President, Justin E. Butler, the Treasurer,
Marvin L. Selge, Jr., the Secretary, Allison Swinehart, and the Project
Managers, Robert P. Kuhns, Robert S. Riley, Christian Baybutt, Ronald J.
White, Jr., Thomas A. Lentz, Mathew Huss, Andrew Boyles and Kyle Silveus
are all authorized to sign construction documents on behalf of the Corporation.
The signature of the President, the Vice President, the Treasurer, the Secretary, or
the Project Manager shall be sufficient to bind the Corporation as to any
construction documents submitted.
5. Ratification of Past Acts
The Shareholders and Directors hereby ratify and reaffirm all corporate actions of
the officers and directors of the Corporation taken between the date of the last
meeting and the date of this Resolution.
Authorization
The officers of the Corporation are authorized and empowered for and on behalf
of the Corporation to do any and all acts and things and execute any and all
additional instruments, papers or documents that may be or become necessary,
desirable, or appropriate to carry out, put into effect, and make operative any
portion of portions of these Resolutions.
DATED: September 1, 2021
Ct�t1v�,
MARON L. S LGE, JR.
,r 4zeLe La
P ANIE ANN BUTLER
a P�Mc--Mlk
"Shareholders"
"Director"
2
BAR BARA S. ELGE
ST1N E. BUTLER
CERTIFIED RESOLUTION
I, ALLISON SWINEHART, hereby certify that I am the duly elected and acting
Secretary of SELGE CONSTRUCTION CO., INC., a Michigan corporation, and that
the following resolution was duly adopted by unanimous consent of the Shareholders and
Directors of said Corporation, on September 1, 2021, and that said resolution is in full
force and effect:
Board of Directors. The following person was elected to serve as director of the
Corporation until the next annual shareholders meeting or until their successors
are elected and take office:
Marvin L. Selge, Jr.
2. Officers. The following persons shall hold the offices set forth opposite their
names until their successors are elected and shall qualify:
Name
James Boyles
Justin E. Butler
Allison Swinehart
Marvin L. Selge, Jr.
Office
President
Vice President
Secretary
Treasurer
IN WITNESS WHEREOF, I have signed this Certified Resolution this 1st day of
September, 2021.
ALLISON SWINEHART
3
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date: 07-01-2024
Name: Jacob M. Klosinski Department of Public Works — Engineering Division
BPW Date: 07-09-2024 Phone Extension: 9496
Required Prior to Submittal to Board
BPW Attorney X Attorney Name Michael Schmidt
Dept. Attorney ® Attorney Name
Michael Schmidt
Purchasing ® Mickey Low / Ron O'Connor
Check the Appropriate Item Type — Required. for All Submissions
❑ Professional Services Agreement ❑ Contract ❑ Proposal
❑ Open Market Contract ❑ Amendment/Addendum ❑ Special Purchase, QPA
❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet
® Quote Opening ® Quote Award ❑ Reject Bids/Quotes
❑ Proposal Opening ❑ C/O & PCA No. ❑ PCA
❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution
n Other: n Ease./Encroach
Company or Vendor Name
New Vendor
MBE/WBE Contractor
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Information
❑ Yes❑ If Yes, Approved by Purchasing
❑ No
❑ ❑
MBE Completed E-Verify Form Attached ❑ Nos
Sewer Repair — Bendix and Westmoor Intersection
124-045
Sewer Operations, Other Contractual Service
PR-00034555: Acct. No. 641-06-602-509-439001
Lumn Sum and Unit Prices
Special Contract Provisions Work to be completed by August 10, 2024
Purpose/Description The Division of Engineering and Sewer Department request the Board of
Public Works open quotations at its meeting on July 9, 2024. The Division of
Engineering would like to review quotations received at the meeting and
provide an award recommendation at the July 9, 2024, Board meeting to
expedite repair work and coordinate materials procurement.
For Change Orders Only
Amount of ❑ Increase $
❑ Decrease ($ )
Previous Amount $
Current Percent of Change
New Amount
Total Percent of Change:
Time Extension Amount:
Increase
Decrease
Increase %
Decrease ( %
New Completion Date:
�/'TRAFFIC CONTROL AND OCCUPANCY REQUEST
City of South Bend - Division of Engineering
l' y 227 W .Jefferson Boulevard, Ste 1316
'a South Bend, IN 46601
APPLICANT INFORMATION
Name of Contractor/Company:
Name of Applicant:
Phone:
On -Site Contact:
PROJECT INFORMATION
Requested Dates (mm/dd/yyyy):
Time of Work:
Email Address:
Phone:
/ /20 to
to
/20
Location of Work: ❑ Entire Street ❑ Travel Lane ❑ Parking Lane
❑ Sidewalk ❑ Tree Lawn ❑ Alley
Type of Work: ❑ Excavation/Boring (Also requires Excavation Form)
❑ New Drive Approach (Also requires Curb Cut Application)
❑ Sidewalk
Address of Project:
Project Boundaries:
Description of Work:
INCLUDE THE FOLLOWING ITEMS WITH YOUR APPLICATION:
❑ Traffic control plan including detour map and traffic devices.
❑ Communication (letter, door hanger, signs, etc.) to affected property owners
Failure to use traffic control for traffic restrictions or closures will result in stop work
orders and/or delay in permitting. This Occupancy Permit Request is non -transferable. A
signature subjects the named contractor/permittee to all applicable rules, duties and
obligations imposed by the South Bend Municipal Code and to all regulations imposed by
the City's Board of Public Works.
Signature of Applicant:
Date:
Applications should be dropped off to the City's Engineering Office or emailed to
rowpermitsoffice@south bend in.gov. For questions, contact Tara Bussell at 574.235.9254.
OFFICE USE ONLY.
Date Received: Fee Paid: Approval Date:
5Ul Lff �
1�/_ - EXCAVATION PERMIT REQUEST
City of South Bend - Division of Engineering
iWf P.A1,
x\ Wa 227 W Jefferson Boulevard, Ste 1316
South Bend, IN 46601
FAPPLICANT INFORMATION
Name of Contractor/Company:
[aITOY=l
PROJECT INFORMATION
Date of Work (mm/dd/yyyy):
Time of Work:
Location of Work Address:
Email Address:
/ /20 to
to
Type of Work: ❑ Cable ❑ Electric ❑ Fiber ❑ Gas ❑ Manhole repair
❑ Sanitary Sewer ❑ Water ❑ Other
Type of Cut: Number of Cuts ❑ Boring ❑Trenching
Cut Location: ❑ In Street ❑ Tree lawn/sidewalk right-of-way
Description of Work:
/20
Excavation in right-of-way WITHOUT a permit will result in a stop work order and/or
delays in permitting. Emergency excavations must be called into the Permits Office at
574.235.9254 no later than noon the following day.
This excavation permit request is non-transferrable. A signature subjects the named
contractor/permittee to all applicable rules, duties and obligations imposed by the City of
South Bend Municipal Code and to all regulations imposed by the City of South Bend's
Board of Public Works.
Signature of Applicant:
Date:
Completed application should be dropped off to the City's Engineering Office or emailed
to rowpermitsoffice@south bend in.gov. For questions, contact the Permits Manager at
574.235.9254.
OFFICE USE ONLY.
Date Received: Fee Paid: Approval Date:
EXCAVATION PERMIT REQUEST (continued)
LIST ALL OTHER CONTRACTORS
First Subcontractor
Name of Subcontractor/Company:
Name of Contact:
Phone:
Second Subcontractor
Name of Subcontractor/Company:
Name of Contact:
Phone:
Third Contractor
Name of Subcontractor/Company:
Name of Contact:
Phone:
Email Address:
Email Address:
Email Address:
Water & Sewer Map for South Bend, IN
June 13, 2024 1-1,128
0 0.0125 0.026 C.06 mi
0.02 0.04 0.08 Ian
City of South Bend
Esr i, HERE I City of South Bend
3218 PRASTBLVD
4
I
�2 e -W ' 1
Ex. Brick Manhole
Remove upper section, casting
and lid.
Salvage casting and lid to City.
Install concrete collar or pre -cast
manhole collar at brick interface.
Install pre -cast concrete
manhole, eccentric cone section.
Install riser rings.
Install casting and lid.
Water & Sewer Map for South Bend, IN
Temporary Bypass Suction Manhole 18-inch
Plug, route bypass piping south on Bendix
Road and east on Westmoor Street
Ex. 6-inch Cast Iron Water Main
Remove segment of water main.
Install 6-inch knife gate valve.
Install new section of 6-inch,
ductile iron, Class 50, water
main pipe.
® 10 -�
t rsrirar-
f:
- .4
Ex. 18-inch Combined
Sewer, Reinforced Concrete
Pipe.
Remove damaged section.
Install reinforced concrete
pipe, coupling and/or
concrete collar, and
reconnect to drop manhole.
'0 ;'t
D
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Temporary Bypass
Discharae Manhole
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