HomeMy WebLinkAboutOpening of Bids - Momentum TIF Project - Site Work - Proj No. 124-018 - Larson-DanielsonVersion 09/29/2024 Contractor’s Bid for Public Works -2
CITY OF SOUTH BEND, INDIANA
CONTRACTOR’S BID FOR PUBLIC WORK
Project Name MOMENTUM SITE IMPROVEMENTS
Project No. 124-018
For Bids Due OCTOBER 22, 2024
PART I
(Must be completed for all bids. Please type or print)
Date:Bidder (Firm):
Address:
City/State/Zip:Telephone Number:()
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:
the City of South Bend, Indiana, in accordance with plans and specifications prepared by:
and dated 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 contract are needed, the cost of units must be the same as that
shown in the original contract if accepted by the City of South Bend. If the bid is to be awarded on a unit
basis, the itemization of the units shall be shown on a separate attachment.
ACCEPTANCE
The above bid 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
By
(Signature)
(Printed Name of Person Signing)
10/22/24 Larson-Danielson Const. Co., Inc.
302 Tyler Street
LaPorte, IN 46350 219 362-2127
Momentum Site Improvements
The Troyer Group
10/22/24
X
Brian T. Larson
LARSON-DANIELSON
CONSTRUCTION CO., INC.
STATEOF
INDIAAN
SEALCorporate
788,791.19
(Enter sum of Total Base Bid plus Alternates shown on Proposal)(Numerical)
Seven Hundred Eighty Eight Thousand, Seven
Hundred Ninety One & 19/100
BID/PROPOSAL
CITY OF SOUTH BEND
Project Name:MOMENTUM SITE IMPROVEMENTS
Project Number:124-018
For Bids Due:OCTOBER 22, 2024
Contractor Name:
BASE BID
30 Blue Acrylic Thermoplastic Pavement
Marking; 4” Width 133 LF
31 Blue Acrylic Thermoplastic Symbol of
Accessibility 2 EA
32 Concrete Sidewalk Grinding 1 LS
BASE BID TOTAL
ALTERNATES
Item
No.Description Quantity Unit Unit Price Total Amount
1 Bola Bike Racks 5 EA
2 Site Lighting and Concrete Base 2 EA
3 Pavers –ADD in Lieu of Concrete 105 SYS
4
Ucara Walls and Stairs - ADD In Lieu of
Concrete Walls and Stairs for ADA
Ramp and Patio Area
1 LS
5 Wausau Tile Benches - Add in Lieu of
Concrete Seat Walls 1 LS
6 Landscaping - Trees, Shrubs,
Perennials, Groundcover, Bulbs, Edging 1 LS
ALTERNATES TOTAL
Bidder (Firm):
Address:
City/State/Zip:Telephone Number:()
By
(Signature)
(Printed Name of Person Signing)
Larson-Danielson Construction Company, Inc.
Larson-Danielson Construction Company, Inc.
302 Tyler Street
LaPorte, IN 219 362-217
46350
X
Brian T. Larson, President
SEE ATTACHED TO FOLLOW
Version 09/29/2024 Contractor’s Bid for Public Works - 3
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.
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: ___________________________________________________________
Bidder (Firm) ___________________________________________________________
Date (month, day, year): _______________________________________________________
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
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
LARSON-DANIELSON CONSTRUCTION CO., INC.
7,391,000.00 GC 2023 LaPorte CSC-Transportation Bldg
5,823,850.00 GC 2024 Hanover CSC-New Resource Ctr.
3,960,546.00 GC 2024 Mishawaka, City of-Riverwalk Extension
5,971,326.00 GC 2024 E. Porter Cty SC-Washington TS
5,340,002.00 GC 2025 South Bend, City of-MLK Dream Center
15,202,000.00 GC 2025 South Bend-Raclin Murphy Encore
6,011,988.00 GC 2025 Build Westville-WV Corr Fac, 02B-Masonry
5,779,538.00 GC 2025 Build Westville-WV Corr Fac, 03A-Gen Trades
City of LaPorte
10/22/24
3. Have you ever failed to complete any work awarded to you? _______________ If so, where and why?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
4. List references from private firms for which you have performed work.
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
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.
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
NO
Wal-Mart Stores, Inc. 2001 SE 10th St. Bentonville, AR 72712
University of Notre Dame 200 Facilities Building Notre Dame, IN 46556
Northwest Health P. O. Box 250 LaPorte, IN 46352
Task Force Tips 2351 Industrial Drive Valparaiso, IN 46383
The Boeing Company 100 N. Riverside Chicago, IL 60606
Larson-Danielson anticipates commencing project coordination upon receipt of a Contract, Notice to Proceed,
or Letter of Intent. We will then begin awarding subcontracts and purchase orders based on sequence of work
to be performed. Work will be performed in common sequence of tasks as generally accepted throughout the
construction industry and as it pertains to this project. Average crew sizes range from 5-6 skilled tradespeople,
although is subject to change based on schedule and the specific task(s) being performed.
Please see attached list of subcontractors we have worked with on public works projects in the last five (5) years.
BID/PROPOSAL
CITY OF SOUTH BEND
Project Name:MOMENTUM SITE IMPROVEMENTS
Project Number:124-018
For Bids Due:OCTOBER 22, 2024
Contractor Name:
BASE BID
Item
No.Description Quantity Unit Unit Price Total Amount
1 Mobilization / Demobilization 1 LS
2 Construction Engineering 1 LS
3 Demolition 1 LS
4 Erosion Control 1 LS
5 Excavation & Grading 1 LS
6 Topsoil –Planter Beds 40 CYS
7 1.5” Asphalt Mill 1170 SYS
8 1.5” HMA Surface 157 TON
9 1.5” HMA Intermediate 87 TON
10 3” HMA Base 173 TON
11 Compacted Aggregate, No. 53, 4”296 TON
12 Concrete, 4"236 SYS
13 Concrete Curb, 6"630 LF
14 Concrete Flush Curb 15 LF
15 Truncated Domes 1 LS
16 Canopy Foundations 1 LS
17 Concrete Walls and Steps for ADA
Ramp 1 LS
18 Handrail, Posts and Cable 230 LF
19 Dry Wells 3 EA
20 Perforated Drain Tile, 6" (w/Sock)150 LF
21 Gas Line 17 LF
22 Irrigation Sleeves 200 LF
23 Steel Pipe Bollards 6 EA
24 Adjust Existing Castings to finish grade 2 EA
25 Fence, Ameristar –4’ Sections 114 LF
26 Fence, Ameristar –6’ Sections 475 LF
27 Decorative Screen 20 LF
28 Concrete Seat Wall, 2’ ((w/ wood seat)81 LF
29 White Acrylic Thermoplastic Pavement
Marking; 4” Width 1256 LF
Larson-Danielson Construction Company, Inc.
SEE ATTACHED TO FOLLOWSEE ATTACHED TO FOLLOWTAC
Version 09/29/2024 Contractor’s Bid for Public Works - 1
CITY OF SOUTH BEND, INDIANA
CONTRACTOR’S BID FOR PUBLIC WORK
CHECKLIST FOR BIDDERS
From time to time the South Bend Board of Public Works finds it necessary to reject a bid because
it does not comply with statutory requirements. In preparing your bid, please use the following
checklist in order to make sure that your bid is done in the proper manner.
Proper bid security included. The bidder has the option of providing either a Certified Check
or Bid Bond.
Bid prepared on the City of South Bend Contractor’s Bid for Public Work Form, completely
executed.
Contractor’s Non-Collusion and Non-Debarment Affidavit, Certification Regarding Investments
with Iran, Employment Eligibility Verification, Non-Discrimination Commitment, and
Certification of use of United States Steel Products or Foundry Products.
Proof of M/WBE Utilization Plans [MBE-1.0 and WBE-1.0]. Also provide Evidence of Good
Faith Efforts Forms [MBE-2.0 and WBE-2.0] and M/WBE Contacted Forms [MBE-2.1 and
WBE-2.1].
Acknowledge Receipt of _____ Addendum(s) included with the bid.
All required additional information is included with the bid.
Proposal statements and other affidavits all signed by the proper party with name either
printed or typed underneath signature.
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: Date:
By Authorized Representative:
Signature:
Print Name & Title:
Project Name MOMENTUM SITE IMPROVEMENTS
Project No. 124-018
For Bids Due OCTOBER 22, 2024
X
X
X
X
X
X
X
X
1
Larson-Danielson Construction Co.,Inc. 10/22/24
X
Brian T. Larson, President
LARSON-DANIELSON
CONSTRUCTION CO., INC.
STATEOF
INDIA AN
SEALCorporate
,2,3
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.
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
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.
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
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.
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
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.
Larson-Danielson does plan to utilize subcontractors. Subcontractor information will be provided as required
in the relevant bidding documents.
Larson-Danielson owns a wide variety of heavy equipment and mid to small sized equipment/tools,
including but not limited to equipment for earthwork, masonry, concrete, carpentry, access equipment and
transportation equipment. Specific lists of equipment will be provided as required by the relevant bidding documents.
YES
SECTION IV CONTRACTOR'S NON – COLLUSION AFFIDAVIT
The undersigned bidder or agent, being duly sworn on oath, says that he 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 include 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.
He 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.
SECTION V OATH AND AFFIRMATION
I HEREBY AFFIRM UNDER THE PENALTIES FOR PERJURY THAT THE FACTS AND INFORMATION
CONTAINED IN THE FOREGOING BID FOR PUBLIC WORKS ARE TRUE AND CORRECT.
Dated at ____________________ this ______________ day of __________________, _______
__________________________________________________________
(Name of Organization)
By________________________________________________________
__________________________________________________________
(Title of Person Signing)
ACKNOWLEDGEMENT
STATE OF ______________________)
) ss
COUNTY OF_____________________)
Before me, a Notary Public, personally appeared the above-named _________________________________ and
swore that the statements contained in the foregoing document are true and correct.
Subscribed and sworn to before me this ____________ day of ___________________, ________.
____________________________________________
Notary Public
My Commission Expires:_____________________
County of Residence:________________________
Larson-Danielson Construction Co., Inc.
Brian T. Larson, President
Indiana
LaPorte
Brian T. Larson
September 8, 2031
LaPorte
LaPorte, IN 22nd October 2024
X
22nd October 2024
X
Michele C. Dzielinski
LARSON-DANIELSON
CONSTRUCTION CO., INC.
S TATEOF
INDIA AN
SEALCorporate
UBLP
IC
YRATON
FINDI ANAOETATSNOTARY
SEAL
Michele Dzielinski Digitally signed by Michele Dzielinski
DN: C=US, E="mcd@ldconstruction,.com",
CN=Michele Dzielinski
Date: 2024.10.22 07:51:09-05'00'
I.35
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“SECTION II, ITEM 2 – BELOW IS A LIST OF
SUBCONTRACTORS THAT WE HAVE USED
ON PUBLIC WORKS PROJECTS DURING
THE PAST FIVE (5) YEARS”
Earthwork/Sitework
D&M Excavating
9896 W. 300 N.
Michigan City, IN 46360
G. E. Marshall
1351 Joliet Rd.
Valparaiso, IN 46384
Pavey Excavating
2020 Ohio St.
LaPorte, IN 46350
McAllister, Inc.
12600 Maple St.
Cedar Lake, IN 46303
Asphalt Paving & Striping
Rieth-Riley Construction
7500 W. 5th Ave.
Gary, IN 46406
Site Services
10117 Kennedy Ave.
Highland, IN 46322
Olson Construction
2239 Summer St.
Hammond, IN 46320
Fencing
Milestone Fence
3723 N. Home St.
Mishawaka, IN 46545
Northwest Indiana Fence
1758 W. Lincolnway
Valparaiso, IN 46383
Landscaping
Fuerbringer Landscaping & Design
22530 Brick Rd.
South Bend, IN 46628
T & J Landscape Service
12615 Wicker Ave.
Cedar Lake, IN 46303
Hubinger Landscaping
210 E. 113th Ave.
Crown Point, IN 46307
Gypsum/Metal Studs/Acoustical
Huggett-Betten
3470 Little Castle Rd.
Stevensville, MI 49127
Kleckner Interior Systems
1176 Damon Lane
Chesterton, IN 46304
Flooring
Midwest Tile & Interiors
1805 N. Cedar Street
Mishawaka, IN 46545
Interior Finishes
3601 McGill St.
South Bend, IN 46628
Art Mosaic & Tile
844 Rush St.
South Bend, IN 46601
Painting
Stan’s Painting & Decorating
440 Sullivan St.
Hobart, IN 46342
Prism Painting
368 Kennedy Ave.
Schererville, IN 46375
Elevators
Otis Elevator
1010 E. Jefferson Blvd.
Mishawaka, IN 46545
I.35
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Schindler Elevator
500 Park Blvd.
Itasca, IL 60143
TK Elevator
940 W. Adams
Chicago, IL 60607
Concrete
Milestone Contractors
24358 SR23
South Bend, IN 46614
C & S Concrete
7353 McConnell Rd.
Lowell, IN 46356
Structural Steel
Omega Structural Steel
1640 Main Street
Griffith, IN 46319
C & C Iron
6409 Hendricks St.
Merrillville, IN 46410
Stevens Iron Works
733 W. 500 N.
Valparaiso, IN 46383
Evans Metal Products
2400 Johnson St.
Elkhart, IN 46514
Roofing
E. C. Babilla, Inc.
3974 Harrison St.
Gary, IN 46408
Korellis Roofing, Inc.
1333 169th St.
Hammond, IN 46324
Midland Engineering
52369 US 933 North
South Bend, IN 46637
Storefront & Entrances & Glazing
Trout Glass & Mirror
3602 Enterprise Ave.
Valparaiso, IN 46383
J.W. Werntz Supply
1002 Kerr St.
South Bend, IN 46601
Lazzaro Co.
5880 Broadway
Merrillville, IN 46410
Fire Protection
Ryan Fire Protection
3715 Bowman Dr.
Valparaiso, IN 46383
F. E. Moran Fire Protection
1454 3rd St.
Osceola, IN 46561
Hill Mechanical
950 Wabash Ave.
Chesterton, IN 46304
Mechanical
Circle R Mechanical
6620 Shepherd Ave.
Portage, IN 46368
D. A. Dodd, Inc.
14 E. Michigan Ave.
Rolling Prairie, IN 46371
BC Mechanical
882 Anderson Rd.
Niles, MI 49120
Bloomfield Mechanical
6636 Melton Rd.
Portage, IN 46368
Electrical
Continental Electric Co., Inc.
9501 E. 5th Ave.
Gary, IN 46403
EMCOR/Hyre Electric Co.
2655 Garfield Ave.
Highland, IN 46322
Circle R Electric
5740 Central Ave.
Portage, IN 46368
15
The name of the partnership firm under which the above partners are operating is ………………………………..…
……………………………………………………………………………………………………………………....…
Give names and titles of all persons having authority to execute and receipt estimate vouchers and to conduct other
business for the partnership, the signatures of whom are legally binding.
……………………………………………………………………………………………………………………....…
……………………………………………………………………………………………………………………....…
The undersigned hereby declares that the foregoing is a true statement of the financial condition of the individual, co-partnership of
corporation herein first named, as of the date herein first given; that this statement is for the express purpose of inducing the party to whom it is
submitted to award the submitter a contract; and that any depository, vendor or other agency herein named is hereby authorized to supply such
party with any information necessary to verify this statement.
……………………….……………………………………
NOTE: A co-partnership must give firm name and signatures of all partners. Brian T. Larson, President
A corporation must give full corporate name, signature of official and affix corporate Larson-Danielson Construction Co., Inc.
Seal.
Affidavit for Individual
STATE OF ……………………….……….
SS:
COUNTY OF …………………………….
………………………………………………………………………….. being duly sworn, deposes and says that the foregoing financial
statement, taken from his books, is a true and accurate statement of his financial condition as of the date thereof and that the answers to the
foregoing interrogatories are true.
Subscribed and sworn to before me this ……………………………………………………
(Applicant must sign here)
………………..day of ………………………. 20 ……
……………………………………………………........
Notary Public
Affidavit for Co-Partnership
STATE OF ……………………….……….
SS:
COUNTY OF …………………………….
………………………………………………………………………….. being duly sworn, deposes and says that that he is a member of the firm
of …………………………………………………………………….; that he is familiar with the books of the said firm showing its financial
condition; that the foregoing financial statement, taken from the books of the said firm, is a true and accurate statement of his financial condition
of the said firm as of the date thereof and that the answers to the foregoing interrogatories are true.
Subscribed and sworn to before me this ……………………………………………………
(Member of firm must sign here)
………………..day of ………………………. 20 ……
……………………………………………………........
Notary Public
Affidavit for Corporation
STATE OF ………INDIANA…….……….
SS:
COUNTY OF ……LA PORTE…………….
…………Brian T. Larson …….. being duly sworn, deposes and says that that he is a member of the firm of …… President……….; of the
………….Larson-Danielson Construction Co., Inc………….., the corporation described in and which executed the foregoing statement; that he
is familiar with the books of the said corporation showing its financial condition; that the foregoing financial statement, taken from the books of
the said firm, is a true and accurate statement of the financial condition of the said corporation as of the date thereof and that the answers to the
foregoing interrogatories are true.
Subscribed and sworn to before me this ……………………………………………………
(Officer must sign here)
……... day of … …..… …. … Brian T. Larson, President
……………………………………………………..................
Michele C. Dzielinski, LaPorte County Resident My Commission Expires: September 8, 2031
22nd October, 2024
LARSON-DANIELSON
CONSTRUCTION CO., INC.
STATEOF
INDIA AN
SEALCorporate
LARSON-DANIELSON
CONSTRUCTION CO., INC.
STATEOF
INDIAAN
SEALCorporate
UBLPICYRATON
FINDIA NAOETATS
NOTARY
SEAL
Michele Dzielinski Digitally signed by Michele DzielinskiDN: C=US, E="mcd@ldconstruction,.com", CN=Michele DzielinskiDate: 2024.10.22 07:52:02-05'00'
Version 09/29/2024 Contractor’s Bid for Public Works - 4
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 ___________ )
) SS:
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.
Indiana
LaPorte
Version 09/29/2024 Contractor’s Bid for Public Works - 5
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 09/29/2024 Contractor’s Bid for Public Works - 6
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 day of , 20__
Contractor/Bidder (Firm)
Signature of Contractor/Bidder or Its Agent
Printed Name and Title
Subscribed and sworn to before me this day of , 20
My Commission Expires
Notary Public
County of Residence
22nd October 24
Larson-Danielson Const. Co., Inc.
X
Brian T. Larson, President
22nd October 24
9/8/31 X
Michele C. Dzielinski
LaPorte
LARSON-DANIELSON
CONSTRUCTION CO., INC.
STATEOF
INDIA AN
SEAL
Corporate
UBLPICYRATON
FINDI ANAOETATSNOTARY
SEAL
Michele Dzielinski Digitally signed by Michele DzielinskiDN: C=US, E="mcd@ldconstruction,.com", CN=Michele DzielinskiDate: 2024.10.22 07:52:21-05'00'
Larson-Danielson Const. Company, Inc. 1 1Brian T. Larson, President X 10/22/24LARSON-DANIELSONCONSTRUCTION CO., INC.STATEOFINDIAANSEALCorporateD.A. Dodd14 E. Michigan St.Rolling Prairie, IN 46371David Siddell219-778-6938Plumbing/Gasline $13,200 2.1%
Larson-Danielson Const. Company, Inc. 1 1Brian T. Larson, President X 10/22/24LARSON-DANIELSONCONSTRUCTION CO., INC.STATEOFINDIAANSEALCorporateRitschard Brothers1204 W. Sample St.South Bend, IN 46619Don Ritschard574-288-4777SWPPP, Sleeves, Demolition, $147,224 23.5%Earthwork, Storm Water Utilities
10/22/24
Larson-Danielson Construction Company, Inc.
302 Tyler Street
LaPorte IN 46350
Brian T. Larson, President 219-362-2127
btl@ldconstruction.com
Larson-Danielson Construction Company, Inc.
302 Tyler Street
LaPorte IN 46350
10/22/24
Brian T. Larson, President 219-362-2127
btl@ldconstruction.com
LARSON-DANIELSON
CONSTRUCTION CO., INC.
STATEOF
INDIAAN
SEAL
Corporate
Larson-Danielson Construction Company, Inc.
X Brian T. Larson, President 10/22/24
See Good Faith Effort to follow
LARSON-DANIELSON
CONSTRUCTION CO., INC.
STATEOF
INDIA AN
SEALCorporate
Larson-Danielson Construction Company, Inc.
X Brian T. Larson, President 10/22/24
See Good Faith Effort to follow
LARSON-DANIELSON
CONSTRUCTION CO., INC.
STATEOF
INDIA AN
SEAL
Corporate
Version 5/20/2024 General Conditions - 1
CITY OF SOUTH BEND, INDIANA
CONTRACTOR’S BID FOR PUBLIC WORK
RESPONSIBLE BIDDER CHECKLIST
Project Name MOMENTUM SITE IMPROVEMENTS
Project No. 124-018
For Bids Due October 22, 2024
Contractor Name:
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.
Larson-Danielson Construction Company, Inc.
If you are a pre-qualified bidder, complete Section I only.
Version 5/20/2024 General Conditions - 1
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 bid and/or intends to hire on any part of the public work project, including individuals
performing work as independent contractors.
2. Each subcontractor, whose portion of the project is estimated to be at least 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 - 1
I. PRE-QUALIFIED BIDDER CHECKLIST
(a) Acknowledgements:
(i) ___ 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) ___ 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) ___ 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) ___ 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) ___ 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) ___ 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) ___ 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) ___ 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.
X
X
X
X
X
X
X
X
p qq
A copy of my Pre-Qualification verification letter
is attached.
Pre-Qualification Verification Letter was
requested from the City of SB. Was not
supplied. We are working on Project #123-056
which warrants our Pre-Qualification Status.
Version 5/20/2024 General Conditions - 1
II. PRE-QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE-QUALIFIED)
(a) Acknowledgements:
(i) ___ By checking this box, I hereby acknowledge that I am not a pre-qualified bidder
with the City of South Bend.
(ii) ___ By checking this box, I hereby acknowledge that the City reserves the right to
request supplemental information, additional verification of any information
provided, and may also conduct random inquiries of my current and prior
customers. The City reserved the right to utilize all information provided in this
submission and all information obtained in inquiries or requests to determine if a
bidder is responsive and responsible. Additionally, I acknowledge that all
information provided to the City shall be regarded as public records.
(iii) ___ By checking this box, I hereby acknowledge that copies of all Applicable
apprenticeship certificates or standards for training programs applicable to the
work performed on the project may be requested at any time and shall be furnished
upon request.
(iv) ___ By checking this box, I hereby acknowledge and ensure that I and all sub-
contractors, from whom I have accepted a bid and/or intend to hire to perform work
on the public work project, are properly licensed. Furthermore, I acknowledge my
understanding that it is my responsibility to ensure that all sub-contractors have
the necessary licenses to undertake the work called for in this bid. If a sub-
contractor loses their license at any point, it is the responsibility of that sub-
contractor to notify the City.
(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:
(i) ___ Indiana Secretary of State’s on-line records (ie. Business verification) dated within
sixty (60) days of the submission of said document showing that business is in
existence, current with the Indiana Secretary of State’s Business Entity Report,
and eligible for a certificate of good standing. (Not applicable to individuals, sole
proprietors or partnerships).
(ii) ___ List identifying all former business names.
(iii) ___ Any determinations by a court or governmental agency any violations of federal
state, or local laws including, but not limited to, violations of contracting or antitrust
laws, tax or licensing laws, environmental laws, Occupational Safety and Health
Act (OSHA), or federal Davis-Bacon and related Acts, within the preceding five (5)
years.
(iv) ___ Statement about staffing capabilities, including labor sources. This statement
indicates and ensures I have sufficient employees on staff to complete the work I
am bidding on OR outlines how I intend to meet the staffing needs of the work.
(v) ___ Statement that individuals who will perform work on the public work project on my
behalf will be properly classified as an employee or as an independent contractor
under all applicable state and federal laws and local ordinances.
(v) ___ 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 - 1
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.
Date: ___________________________________________
________________________________________________
(Sign Here)
________________________________________________
(Print Name Here)
________________________________________________
(Name of Company)
________________________________________________
(Address of Company)
________________________________________________
(City)
________________________________________________
(State)
________________________________________________
(Telephone Number)
10/22/24
X
Brian T. Larson, President
302 Tyler Street
IN 46350
219-362-2127
Larson-Danielson Construction Company, Inc.
LaPorte
LARSON-DANIELSON
CONSTRUCTION CO., INC.
STATEOF
INDIA AN
SEAL
Corporate
PROJECT: City of South Bend-Momentum Site Improvements
Bid Date: 10/22/24
RE: Responsible Bidding Practices Submittal
All Larson Danielson labor is provided through local trade unions.
_____________________________
Jeff R. Jensen
Secretary-Treasurer
302 Tyler Street LaPorte, Indiana 46350
(219) 362-2127 Fax (219) 362-2848
LARSON-DANIELSON
CONSTRUCTION CO., INC.
S TATEOF
INDIA AN
SEALCorporate
December 7, 2023
C/O Larson Danielson
To Whom It May Concern,
This is a letter of recommendation on behalf of LLarson Danielson. The BAC 4 IN/KY
Apprenticeship & Training Program is a statewide program that was established in 1994
and is recognized by the U. S. Department of Labor and is considered in good standing.
Larson Danielson has been a “signatory union contractor” since 1996 and at the present
time employ enrolled apprentices. Larson Danielson has continued to follow the guidelines
set forth in Collective Bargaining Agreement with BAC Local #4 IN/KY meeting the
required Journeyman/Apprentice ratio on their jobs.
Should you have any further questions please feel free to contact the State office at
(219) 525-4443.
Sincerely,
Roger Jones
Managing Director
BAC 4 IN/KY Apprenticeship & Training Program
!
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