HomeMy WebLinkAboutOpening of Bids - Momentum TIF Project - Site Work - Proj No. 124-018 - PanzicaCITY 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)
1
1
Version 8/11/2020
CITY OF SOUTH BEND, JAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS
1316 COUNTY-CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND, INDIANA 46601-1830
PHONE 574/ 235-9251 FAX 574/ 235-9171 TDD 574/ 235-5567
Date: October 8, 2024 To: All Planholders
From Theresa Heffner, Clerk, Board of Public Works
Subject Addendum Number: 1
Project Name: Momentum TIF Project – Site Work
Project Number: 124-018
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM
Date Received:
This addendum is being forwarded to you for the above referenced project. Please sign below and acknowledge receipt of this Addendum
by including with your electronic bid submission.
THIS ADDENDUM MAY AFFECT YOUR BID.
Notes: \ The attached documents are hereby added to the Specifications and Contract
Documents and become a part of herein.
Company:
Authorized Signature:
Date:
10/17/24
Date: October 15, 2024
To: All Bidders
From Theresa M. Heffner, Clerk, Board of Public Works
Subject Addendum Number: 2
Project Name: Momentum Site Improvements
Project
Number: 124-018
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM
Date Received:
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.
A copy MUST also be included with your bid package upon
submittal.
THIS ADDENDUM MAY AFFECT YOUR BID.
Note:
The attached documents are hereby added to the Specifications and Contract
Documents and become a part of herein.
Company:
Authorized Signature:
Date:
CITY OF SOUTH BEND JAMES MUELLER, MAYOR
BOARD OF PUBLIC WORKS
1316 COUNTY-CITY BUILDING
227 W. JEFFERSON BOULEVARD
SOUTH BEND, INDIANA 46601-1830
PHONE 574/ 235-9251
FAX 574/ 235-9171
TDD 574/ 235-5567
10/17/2024
Version 8/11/2020
CITY OF SOUTH BEND, JAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS
1316 COUNTY-CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND, INDIANA 46601-1830
PHONE 574/ 235-9251 FAX 574/ 235-9171 TDD 574/ 235-5567
Date: October 18, 2024 To: All Planholders
From Theresa Heffner, Clerk, Board of Public Works
Subject Addendum Number: 3
Project Name: Momentum TIF Project – Site Work
Project Number: 124-018
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM
Date Received:
This addendum is being forwarded to you for the above referenced project. Please sign below and acknowledge receipt of this Addendum
by including with your electronic bid submission.
THIS ADDENDUM MAY AFFECT YOUR BID.
Notes: \ The attached documents are hereby added to the Specifications and Contract
Documents and become a part of herein.
Company:
Authorized Signature:
Date:
10/21/2024
Version 5/20/2024 General Conditions - 13
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 - 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.
Date: ___________________________________________
________________________________________________
(Sign Here)
________________________________________________
(Print Name Here)
________________________________________________
(Name of Company)
________________________________________________
(Address of Company)
________________________________________________
(City)
________________________________________________
(State)
________________________________________________
(Telephone Number)
Prequalification Checklist – Attachments
ii. List identifying all former business names
• Panzica Construction Inc. – 2-10-1976 – 7-7-1989
• Panzica Building Corporation – 7-7-1989 – Present
iii. Any determinations by a court or governmental agency any violations of federal
state, or local laws.
• None
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.
• We have adequate staff to complete the project.
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.
• All staff of Panzica Building Corporation are employees and not independent contractors.
viii. Written statement of any federal, state or local tax liens or delinquencies owed in
the preceding 3 years.
• Panzica Building Corporation has no liens or delinquencies during this period.
Similar Projects Completed in Past 3 Years
1. Three Twenty at the Cascade
$19,511,584 Project Value
New Mid-rise Building and Site Improvements for Mixed Use Condominiums.
2. Beacon Nappanee Clinic
$5,144,644 Project Value
New Building and Site Improvements for Medical Clinic.
3. Beacon Dunlap Outpatient Center
$7,178,277 Project Value
New Building and Site Improvements for Medical Clinic and Outpatient Services.
4. Beacon Granger Hospital - MRI Addition
$2,862,057 Project Value
Addition and Site Improvements for New MRI Center.
5. Beacon Ambulatory Surgery Center
$14,410,785 Project Value
New Building and Site Improvements for New Surgery Center.
6. Beacon Corporate Services
$12,466,877 Project Value
New Building and Site Improvements for Medical System Corporate Offices.
7. The Portage School of Leaders – Career Academy of South Bend
$12,650,000 Project Value
New Additions, Interior Renovation, and Site Improvements for New School.
8. The Cascade Restaurant – Navarre Hospitality
$1,500,000 Project Value
Interior Buildout and Site Improvements for New Restaurant.
9. Career Academy Expansion – 3919 Annex Building
$1,273,000 Project Value
Interior Remodel, Buildout and Site Improvements for School.
10. Career Academy South Bend – Welding Shop Renovation
$671,150 Project Value
Interior Renovation and Site Improvements for Welding Shop at School.
11. Career Academy South Bend – P.E. Athletic Field
$418,608 Project Value
Site Improvements for New P.E. Athletic Field at School.
12. Success Academy South Bend at Boys & Girls Club
$2,198,402 Project Value
Interior Remodel and Site Improvements for New School.
13. Jordan Lexus
$4,596,783 Project Value
Interior/ Exterior Remodel and Site Improvements for Auto Dealership.
14. Dr. Tiffany Szymarek Elkhart Ophthalmology
$666,648 Project Value
Interior Remodel for Ophthalmology Clinic.
15. Macri’s Bakery & Restaurant
$780,000 Project Value
Interior Remodel and Site Improvements for Bakery and Restaurant
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
2
2
3
3
4
4
5
5
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.
7
7
Projects Completed in Past Year
1. The Portage School of Leaders – Career Academy of South Bend
$12,650,000 Project Value
Additions, Interior Remodel, and Site Improvements.
2. The Cascade Restaurant – Navarre Hospitality
$1,500,000 Project Value
Interior Buildout and Site Improvements.
3. Career Academy Expansion – 3919 Annex Building
$1,273,000 Project Value
Interior Remodel, Buildout and Site Improvements.
4. Success Academy South Bend at Boys & Girls Club
$2,198,402 Project Value
Interior Remodel and Site Improvements.
5. Jordan Lexus
$4,596,783 Project Value
Interior/ Exterior Remodel and Site Improvements
6. Dr. Tiffany Szymarek Elkhart Ophthalmology
$666,648 Project Value
Interior Remodel
7. Macri’s Bakery & Restaurant
$780,000 Project Value
Interior Remodel and Site Improvements
Public Works Projects Currently in Process
Panzica Building Corp. does not have any Public Works projects currently in
progress
Failure to Complete Awarded Work
Panzica Building Corporation has not failed to complete any work awarded.
Public Works Projects Currently in Process
No public works projects are currently in process.
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.)
Material Quotes
Panzica has received quotations for all materials and were used to
substantiate pricing with proposal using available information in Bid
Documents.
1. Upon award, release subcontractors and suppliers immediately, and
issue subcontracts and purchase agreements for work.
2. Provide a written project schedule for the project team, including
subcontractors and suppliers.
3. Provide material submittals and shop drawings within two-three weeks
to Troyer Group for their review.
4. Mobilize for selective 2024 Fall/ Winter work onsite, including Site
demolition and concrete foundations. Complete 2024 portion of work
and demobilize during Winter.
5. Mobilize for 2025 portion of work in late February/ early March 2025.
6. Provide supervision onsite and project manager in our office to manage
Panzica Building Corp.’s work and multiple subcontractors and their
work onsite.
7. Coordinate work onsite with Panzica Building Corp.’s ongoing building
renovation work for Momentum Development and Site utilities by utility
contractors.
8. Complete 2025 portion of work prior to Building substantial completion
and occupancy on Friday, 5/2/25.
Subcontractor’s Used on Public Works Projects in Past 5 Years
Panzica Building Corporation has not attempted any Public Works Projects
within 5 years.
Equipment Available
Equipment is provided through rental or by Panzica Building Corp.’s
subcontractors .
Subcontractor List (preliminary) – Momentum Site Improvements
Demolition/Earthwork Ritschard Bros., Inc. 1204 W. Sample St,
South Bend, IN 46619
Paving Milestone Contractors 24358 IN-23, South
Bend, IN 46614
Concrete Universal Services 22588 Roosevelt Rd,
South Bend, IN 46614
Railings & Misc. Metal Evans Metal Products 2400 Johnson St.,
Elkhart, IN 46514
Fencing Milestone Fence 3723 N. Home St.,
Mishawaka, IN 46545
Electrical Grove Electrical
Services
55540 Apple Rd.,
Osceola, IN 46561
Screen Wall Legacy Consulting &
Renovations
1344 Brown Ln, South
Bend, IN
Pavers - Alternate Rustic Rock 11 Willowdale, Elkhart,
IN 46514
Representative Client References – October, 2024
Lawrence Garatoni, COB
Career Academy Network of Public Schools
3801 Crescent Circle
South Bend, IN 46628
574-299-9800 office
larry.garatoni@garatonifo.com
Bennett Ratliff, President
Ratliff Group
P.O. Box 860398
Plano TX 75086
214-707-2924 Cell
bennett@ratliffgroup.com
Lori McLaughlin, Principal
Westshore, LLC
c/o 401 East US Highway 30
Schererville, IN 46375
219-864-0700 office
lmclaughlin@westshorellc.com
Jacqueline Kronk, Chief Executive Officer
Boys & Girls Clubs Northern Indiana Corridor
502 E. Sample St.
South Bend, IN 46601
574-232-2048 office
jkronk@bgcsjc.org
ANNUAL REPORT
December 31, 2023
South Bend, Indiana CONFIDENTIAL
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
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)
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.
Project Number: 124-018 Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder: Total Bid Amount: MBE Goal:
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/Proposal
Submitted by:
Print Name Signature Date
13
13
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.
Project Number: 124-018 Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder: Total Bid Amount: WBE Goal:
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:
Print Name Signature Date
14
14
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: 124-018 Date:
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
Contact Person: Telephone:
Address:
City: State: Zip:
Email:
To determine whether a bidder has demonstrated good faith efforts to reach the MBE utilization goals set forth in
the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or commissions,
REQUIRE ALL of the following Good Faith Efforts as listed in the table below*:
EVIDENCE OF GOOD FAITH EFFORTS
MBE LIST(S): The bidder reviewed 1) the City of South Bend’s Minority and Women Business Enterprise
Inclusion Program Plan; 2) the list of certified MWBEs provided by the City; and 3) the Indiana Department
of Administration list of Minority and Women Owned Businesses (both certified and non-certified) found
at: http://www.in.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
Inclusion Program Plan and the Indiana Department of Administration’s certified list of
Indiana Minority and Women Business Enterprises, found on their website
(http://www.in.gov/idoa).
I affirm that I have made good faith efforts to select portions of the contract work to be
performed by MWBEs, including, where appropriate, breaking out contract work items into
economically feasible units to facilitate MBE participation.
I affirm that I have made good faith efforts to solicit through all reasonable and available
means the interest of all MBEs in the scopes of work of the contract.
I affirm that I attended all pre-bid meetings scheduled by the City of South Bend to inform
MBEs of contracting and subcontracting opportunities.
I affirm that I advertised in general circulation and/or trade association publications
concerning subcontract opportunities and allowed MBEs reasonable time to respond to
such advertisements.
I affirm that I performed any and all necessary steps to provide written notices in a manner
reasonably calculated to inform MBEs of subcontracting opportunities and allowed
sufficient time for MBEs to participate effectively.
I affirm that I followed up on initial solicitations with interested MBEs.
I affirm that I negotiated with interested MBEs in good faith, including providing such MBEs
with adequate information about the plans, specifications and other requirements of the
subcontract.
I affirm that I have made good faith efforts to assist interested MBEs in obtaining bonding,
lines of credit, or insurance as required by the City or the bidder, where appropriate.
15
15
I affirm that I have made good faith efforts to assist interested MBEs in obtaining necessary
equipment, supplies, materials, or related assistances or services, where appropriate.
I affirm that I did not reject any MBEs as unqualified without sound business reasons based
on a thorough investigation of their capabilities.
CONTRACT RECORDS: The bidder has maintained the following records for each MBE that has bid on
the subcontracting opportunity:
1. Name, address, and telephone number;
2. A description of information provided by the bidder or subcontractor; and
3. A statement of whether an agreement was reached, and if not, why not, including any reasons for
concluding that the MBE was unqualified to perform the job.
*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.
16
16
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: 124-018 Date:
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
Contact Person: Telephone:
Address:
City: State: Zip:
Email:
To determine whether a bidder has demonstrated good faith efforts to reach the WBE utilization goals set forth in
the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or commissions,
REQUIRE ALL of the following Good Faith Efforts as listed in the table below*:
EVIDENCE OF GOOD FAITH EFFORTS
WBE LIST(S): The bidder reviewed 1) the City of South Bend’s Minority and Women Business Enterprise
Inclusion Program Plan; 2) the list of certified MWBEs provided by the City; and 3) the Indiana Department
of Administration list of Minority and Women Owned Businesses (both certified and non-certified) found
at: http://www.in.gov/idoa/.
GOOD FAITH EFFORTS TO OBTAIN WBE PARTICIPATION
The bidder shall initial each item below, as evidence of its good faith efforts to obtain WBE participation
in the awarded contract.
I affirm that I reviewed the City of South Bend’s Minority and Women Business Enterprise
Inclusion Program Plan and the Indiana Department of Administration’s certified list of
Indiana Minority and Women Business Enterprises, found on their website
(http://www.in.gov/idoa).
I affirm that I have made good faith efforts to select portions of the contract work to be
performed by WBEs, including, where appropriate, breaking out contract work items into
economically feasible units to facilitate WBE participation.
I affirm that I have made good faith efforts to solicit through all reasonable and available
means the interest of all WBEs in the scopes of work of the contract.
I affirm that 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
concerning subcontract opportunities and allowed WBEs reasonable time to respond to
such advertisements.
I affirm that I performed any and all necessary steps to provide written notices in a manner
reasonably calculated to inform WBEs of subcontracting opportunities and allowed
sufficient time for WBEs to participate effectively.
I affirm that I followed up on initial solicitations with interested WBEs.
I affirm that I negotiated with interested WBEs in good faith, including providing such WBEs
with adequate information about the plans, specifications and other requirements of the
subcontract.
I affirm that I have made good faith efforts to assist interested WBEs in obtaining bonding,
lines of credit, or insurance as required by the City or the bidder, where appropriate.
17
17
I affirm that I have made good faith efforts to assist interested WBEs in obtaining
necessary equipment, supplies, materials, or related assistances or services, where
appropriate.
I affirm that I did not reject any WBEs as unqualified without sound business reasons
based on a thorough investigation of their capabilities.
CONTRACT RECORDS: The bidder has maintained the following records for each WBE that has bid on
the subcontracting opportunity:
1. Name, address, and telephone number;
2. A description of information provided by the bidder or subcontractor; and
3. A statement of whether an agreement was reached, and if not, why not, including any reasons for
concluding that the MWBE was unqualified to perform the job.
*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.
18
18
1
Kaine Kanczuzewski
From:Kaine Kanczuzewski
Sent:Thursday, October 3, 2024 2:26 PM
To:Kaine Kanczuzewski
Cc:Jeff Novotny
Subject:Momentum (Former Salvation Army) - Site Improvements - Invitation to Bid - Due
10/21/24 at 3 PM
Attachments:Momentum_Site Improvements Bid Set Plans.pdf; Momentum_Site Improvements
Project Manual.pdf; Scope Tab Sheet 100224.pdf
Importance:High
TrackingTracking:Recipient Read
Kaine Kanczuzewski
Jeff Novotny Read: 10/4/2024 2:37 PM
1stclasslogistics2013@gmail.com
e.t.newman5656@gmail.com
camibowling@coreborein.com
camibowling@coreborein.com
SBoling@Eco-Patcher.com
afrost747@gmail.com
peri@jewelcontractingllc.com
jordanshomeremodelingllc@gmail.com
Kelsey@kbenterprise.us
Kennedyexpressline@yahoo.com
kpritchard@k-pem.com
consult.legacyrenovation@gmail.com
terrimcmann@mcmannelectric.com
rareearth14@gmail.com
shurneman@yahoo.com
rickyataylor19@gmail.com
Lynn@thebancroftcompanies.com
varietychoiceservices@gmail.com
veraconstructionremodel@gmail.com
mwilburn@att.net
RE: Momentum Site Improvements Project – Invitaঞon to Bid
o Panzica Construction Company (PBC) is a general contractor soliciting proposals from MBE and WBE
certified subcontractors & suppliers for the Momentum (former Salvation Army) Site Improvements
Project for the City of South Bend Department of Public Works.
PBC is already active on-site with the remodel of the Salvation Army building, which the parking lot will
be utilized for.
2
o There is non-mandatory but encouraged Pre-bid Meeting with the City on Monday October 7th, at 9
AM. Trade bids are due on October 21st, 2024 at 3 PM.
o Please see attached for the Bidding Documents.
o If you require any assistance accessing or understanding the bid documents, please email your request,
including your company's name & contact information to Kaine@panzica.net and
Jsnovotny@panzica.net. Please be sure to provide the project name in the subject line.
PROJECT SUMMARY:
o Project Scope of Work: See attached “Scope Tab Sheet” for reference. Work includes the
sawcutting/removal of partial existing asphalt parking lot, miscellaneous site demolition, installation of
new drywells, place/compaction of aggregate sub-base, grading, new asphalt (both full depth and
surface only), concrete foundations, concrete flatwork, concrete retaining walls/ramps/stairs, conduit,
gas lines, landscaping, and misc. site furnishings.
o We’ll follow-up with a phone call within the next couple business days.
SPECIAL ACCOMMODATIONS:
o Please advise us should your company require special accommodations with payment terms, bonding, or
insurance, in order to provide pricing for this project.
o We can also assist qualified minority and women businesses in need of assistance procuring equipment
and materials; we will gladly work with your material suppliers to set up joint check agreements.
o Panzica Construction Company is open to negotiations of payment arrangements to all M/WBE
businesses to assist qualified minority and women businesses with their cash flow, which means a
commitment to pay M/WBE's within 30 days after the Contractor confirms that the work has been
performed & completed correctly. Should the terms of this policy be unacceptable for your company, we
will gladly negotiate terms; however, these arrangements must be completed before the bid date.
o If your company requires our help with a specific scope of work, which is economically feasible &
realistic for your company, and/or if you feel a scope of work is too large for your firm to handle
individually, please do not hesitate to contact us. We can assist qualified M/WBE businesses in
developing scopes of work.
PROJECT BIDDING REQUIREMENTS:
o Bids must be submitted using the provided Panzica Construction Company Bid Form.
o Completion of the City of South Bend'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.
o The project does not have a Prevailing Wage requirement.
o The project does require bi-weekly Cerঞfied Payroll.
3
We request that you reply to this email with your company's intent or declinaঞon to bid.
Thanks for your Ɵme,
Kaine Kanczuzewski
Project Manager
Panzica Building Corporation
574.800.6491 phone
574.220.8366 cell
KaKanczuzewski@panzica.net
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
MBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 15
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: 124-018 MBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
10/02/24
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
MBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 15
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: 124-018 MBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
10/02/24
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
MBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 15
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: 124-018 MBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
10/02/24
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
MBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 15
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: 124-018 MBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
10/02/24
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
WBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 16
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: 124-018 WBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
WBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 16
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: 124-018 WBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
WBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 16
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: 124-018 WBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
MBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 15
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: 124-018 MBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
10/02/24
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
MBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 15
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: 124-018 MBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
10/02/24
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
WBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 16
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: 124-018 WBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
WBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 16
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: 124-018 WBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
WBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 16
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: 124-018 WBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
MBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 15
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: 124-018 MBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
10/02/24
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
WBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 16
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: 124-018 WBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
WBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 16
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: 124-018 WBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
WBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 16
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: 124-018 WBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
MBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 15
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: 124-018 MBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
10/02/24
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
WBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 16
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: 124-018 WBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
WBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 16
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: 124-018 WBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
MBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 15
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: 124-018 MBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
10/02/24
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
MBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 15
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: 124-018 MBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
10/02/24
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
MBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 15
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: 124-018 MBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
10/02/24
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
WBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 16
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: 124-018 WBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
MBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 15
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: 124-018 MBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
10/02/24
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
MBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 15
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: 124-018 MBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
10/02/24
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
WBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 16
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: 124-018 WBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
MBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 15
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: 124-018 MBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
10/02/24
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
MBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 15
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: 124-018 MBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
10/02/24
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
MBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 15
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: 124-018 MBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
10/02/24
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
MBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 15
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: 124-018 MBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
10/02/24
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
WBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 16
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: 124-018 WBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
MBE CONTACTED
Version 09/29/2024 Contractor’s Bid for Public Works - 15
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: 124-018 MBE Participation Goal
Project Name: MOMENTUM SITE IMPROVEMENTS
Bidder:
By:
(Signature) (Title) (Date)
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:
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:
10/02/24
Page 1 of 2
ESTIMATE
Prepared For
MOMENTUM SITE IMPROVEMENTS Project
No. 124-01 Panzica Building Corporation
416 E Monroe St, #320
South Bend, IN 46601
(574) 800-6491
(574) 220-8366
Legacy Consulting & Renovation LLC
1344 BROWNE LANE
South Bend , IN 46615
Phone: (317) 744-4227
Email: consult.legacyrenovation@gmail.com
Estimate #3
Date 10/19/2024
Business / Tax #+13177444227
Description Total
Prefabricated Line product 20'0 Linear feet.$6,000.00
Labor cost
Decorative screen $28,600.00
(Material list.) Pricing per linear foot of Prefabricated LINE. $970 per lft ×20. In addition
to delivery 11%, $300.00 delivery fee. $28,350.00 materials cost. With a mark-up on material,
it's estimated costs 13% /11% delivery fee. Anchors screws
Subtotal $34,600.00
Total $34,600.00
Page 2 of 2
MOMENTUM SITE IMPROVEMENTS Project No.
124-01 Panzica Building Corporation
ESTIMATE #DATE EXPIRES
57 10/20/2024
AlphaJak LLC, Phone: (574) 800-4810 Fax: (574) 800-4811
118 N Race street, Mishawaka, Indiana 46544, License # 202002291377336, Business # 84-4746065
Page 1
Title: MOMENTUM
CUSTOMER
PANZA BILUDING CORPORATION
KAINE KANCZUZWESKI
OverHead/Office Qty Cost/Unit Total
Administrative cost 40 $110.38/Hourly $4,415.04
Bonding 1 $1,116.00 $1,116.00
Insurance 30 $64.00/Per Day $1,919.88
Labor Overhead:120 $19.20 $2,304.00
Marketing and Business Development 1 $9.60 $9.60
Legal and Professional Services:2 $180.00 $360.00
Safety and Compliance:1 $972.00 $972.00
Financial Expenses:1 $60.00 $60.00
Miscellaneous Expenses:10 $120.00 $1,200.00
Fuel & Maintenance (per day)30 $120.00 $3,600.00
Equipment Transportation (per mile/trip)4 $285.60 $1,142.40
Project Management (per hour)120 $99.00 $11,880.00
Site Mobilization/Demobilization (per project)1 $7,184.69/EA $7,184.69
158 miles @ 0.78 per mile= $123.24
4 hotel room per week @ $1466.00 each= $5864.00
Permits & Fees (per project)1 $120.00 $120.00
Subtotal: $36,283.61
Labor Cost Qty Cost/Unit Total
site Supervisor/foreman (per hour)120 $78.00/Hrs $9,360.00
3 Man Labor Crew (per hour)120 $270.00/Hrs $32,400.00
Machine Operator 120 $102.76/Hourly $12,330.72
ESTIMATE #DATE EXPIRES
57 10/20/2024
AlphaJak LLC, Phone: (574) 800-4810 Fax: (574) 800-4811
118 N Race street, Mishawaka, Indiana 46544, License # 202002291377336, Business # 84-4746065
Page 2
Subtotal: $54,090.72
Equipment Cost Qty Cost/Unit Total
Asphalt Paver (per day)30 $520.02 $15,600.60
Asphalt Roller (per day)30 $575.40 $17,262.00
Tack Distributor (per day)30 $815.40 $24,462.00
Concrete Saw (per day)30 $420.00 $12,600.00
Excavator 30 $640.55/Daily $19,216.44
TRUCK 30 $68.16 $2,044.80
TRUCK 30 $93.38 $2,801.52
1 TON P/UP TRUCK 4WD DIESEL 30 $145.08/Daily $4,352.40
2022 Graco 3500 Line Striper 14 $33.77/Per Day $472.75
LLV 3900
STANDARD 17H449
ADA HandiCap Stencil 2 $180.00/Each $360.00
Subtotal: $99,172.51
Materials Qty Cost/Unit Total
Surface Type A & B (P63)157 $129.06/TON $20,262.42
Base Material (cubic yard)173 $48.00 $8,304.00
Tack Coat (gallon)23 $6.41 $147.38
#53 CRUSHED CONCRETE (SP)293 $21.37/TON $6,262.00
Recycled concrete used as aggregate for base material or as a substitute for gravel in various construction applications.
Hot Applied Thermoplastic - White 314 $0.98/LB $308.98
Thermoplastic (Preform) Line 4†x 3' - Blue 125MIL 133 $1.51/LFT $201.10
#5 HMA BASE (SOUTHBEND PLANT)173 $101.93/TON $17,633.54
MIX CODE 324/624
#8 HMA INTERMEDIATE (SP)87 $110.15/TON $9,582.88
MIX CODE 334/634
Subtotal: $62,702.30
ESTIMATE #DATE EXPIRES
57 10/20/2024
AlphaJak LLC, Phone: (574) 800-4810 Fax: (574) 800-4811
118 N Race street, Mishawaka, Indiana 46544, License # 202002291377336, Business # 84-4746065
Page 3
Subtotal $252,249.14
Tax: (0%)$0.00
Total $252,249.14
ESTIMATE #DATE EXPIRES
57 10/20/2024
AlphaJak LLC, Phone: (574) 800-4810 Fax: (574) 800-4811
118 N Race street, Mishawaka, Indiana 46544, License # 202002291377336, Business # 84-4746065
Page 4
TERMS & CONDITIONS
GENERAL TERMS AND CONDITIONS
THE FOLLOWING EXPRESS TERMS AND CONDITIONS WHICH SHALL CONSTITUTE THE ENTIRE
CONTRACT (THE “CONTRACT”) BETWEENAlphaJak SERVICES,.(“ALPHA”) AND THE CLIENT (“CLIENT”).
1. TERMS AND CONDITIONS.. The Contract contains the final and complete agreement between the parties and
there are no representations or warranties, expressed or implied, with respect to services specifically set forth
herein..
2. INDEMNIFICATION. The Client waives any claim against ALPHA, and agrees to defend, indemnify and hold
ALPHA harmless from any claim or liability for injury or loss, including all attorney fees and defense costs,
arising or allegedly arising from or in any way connected with ALPHA services under this Contract, except where
such claim or liability is caused by the gross negligence or willful misconduct of ALPHA. The Client also agrees
to defend, indemnify and hold ALPHA harmless from any claim or liability, injury or loss,
including all attorney fees and defense costs, arising in whole or in part from the negligent act or omission,
and/or strict liability of the Client or anyone directly or indirectly employed by the Client. ALPHA does not
guarantee the completion of performance of contracts by third parties, nor is it responsible for their acts or
omissions, nor for the safety of any workplace other than ALPHA premises. Client shall not prematurely subject
the work to any type of traffic; loads in excess of the design capacity before proper cure, or in a manner which
may damage the work. ALPHA is not responsible for graffiti, tire tracks, footprints, etc. on finished asphalt.
ALPHA shall not be held liable for damage to surrounding areas of driveway, parking lot, landscaping or
sidewalks due to poor subgrade, moisture or other unforeseen circumstances. The removal of vehicles from the
work site is the sole responsibility of the Client. Damage to vehicles left on the worksite is the responsibility of
the Client. ALPHA is not responsible for crack fill that adheres to tires. ALPHA is not responsible for overspray
on vehicles, curb and gutter, and all structures within 50 feet of the edge of the parking lot and/or area being
sealed or treated.
3. COMPENSATION. Unless stated otherwise in a Letter of Agreement between ALPHA and the Client, the
compensation for services will be billed in accordance with the agreed upon rates, subject to change upon
notification.
4. PAYMENT TERMS. Payment terms are 50% upfront and remainder 50% upon completion of services
rendered, unless special written arrangements have been made. If payment is not made in accordance with these
terms, the purchaser agrees to pay any collection, legal fees and interest for any unpaid balances. All unpaid
amounts beyond the due date shall bear interest at the rate of 3% per month until paid. The pricing contained
herein is based on work being completed within 30 days of the date of this signed proposal unless otherwise
agreed in writing. Upon completion of the services rendered by AlphaJak and the presentation of the final
invoice, the customer agrees to provide final payment within 10 days of receipt of such final invoice. In the event
that such invoice is not paid in that 10 day period, AlphaJak reserves the right to charge interest at 1% per for
ESTIMATE #DATE EXPIRES
57 10/20/2024
AlphaJak LLC, Phone: (574) 800-4810 Fax: (574) 800-4811
118 N Race street, Mishawaka, Indiana 46544, License # 202002291377336, Business # 84-4746065
Page 5
each month that the invoice remains unpaid. In the event that AlphaJak is forced to retain an attorney to collect
such an invoice and AlphaJak prevails in a Court of law, AlphaJak shall be entitled to reimbursement by customer
for any and all costs, including attorneys’ fees, associated with any such legal action."
AlphaJak warrants that at the time and place we perform services, our materials will be of good quality and will
conform with the specifications contained in Agreement on the date of acceptance of the services. THE
FOREGOING WARRANTY SHALL BE EXCLUSIVE AND IN LIEU OF ANY OTHER WARRANTY EXPRESS OR
IMPLIED, INCLUDING THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A
PARTICULAR PURPOSE AND ALL OTHER WARRANTIES OTHERWISE ARISING BY OPERATION OF LAW,
COURSE OF DEALING, CUSTOM OF TRADE OR OTHERWISE. As the exclusive remedy for breach of this
Warranty, we will replace defective materials, provided, however, that the customer examines the materials
when received and promptly notify us in writing of any defect before any attempt to repair has been made.
Notwithstanding anything in any purchase order, agreement, instrument or other document to the contrary,
AlphaJak’s liability to the customer, if any, in connection with AlphaJak’s product shall be limited to the purchase
price for such product actually paid by the customer to AlphaJak. AlphaJak hereby disclaims any and all
incidental, consequential, special and punitive damages of any kind, nature or description whatsoever. No
person or entity shall be a third party beneficiary of any contract or agreement between AlphaJak and the
customer nor shall AlphaJak have any obligation or duty to any person or entity, other than the customer. One
Year, (12) months after AlphaJak has provided all services, our Warranty and other duties with respect to the
quality of the materials delivered shall conclusively be presumed to have been satisfied, all liability therefore
terminates, and no action for breach of any such duties, may thereafter be commenced. Unless otherwise agreed
to in writing, no warranty is made with respect to materials not manufactured by AlphaJak. We cannot warrant
or in any way guarantee any particular method of use or application or the performance of materials under any
particular condition. Neither this Warranty nor our liability may be extended by our sales personnel, distributors
or representatives, or by any sales information or drawings.
For projects that will exceed 30 days in length, ALPHA reserves the right to invoice for any work done within
that month.
5. TAXES. All sales taxes or use taxes, whether now existing or hereinafter imposed or modified, or taxes or
duties of any nature whatsoever which may be assessed, shall be paid by the Client. In the event ALPHA is
required to pay any such tax, the Client shall reimburse ALPHA therefore on demand..
6. CREDIT. This contract is given and accepted subject to ALPHA approval of the Client’s credit, determinable at
any time and from time to time by ALPHA in its sole judgment, affecting the whole or any unfulfilled portion of
this contract.
7. LEGAL ENFORCEMENT OF GENERAL CONDITIONS. If any portion of this Contract is found to be
unenforceable, the remaining portions of the Contract shall remain in effect and enforced.
8. MODIFICATION OF AGREEMENT. The foregoing conditions may be modified only by written agreement
and signed by duly authorized representatives of ALPHA and the Client.
ESTIMATE #DATE EXPIRES
57 10/20/2024
AlphaJak LLC, Phone: (574) 800-4810 Fax: (574) 800-4811
118 N Race street, Mishawaka, Indiana 46544, License # 202002291377336, Business # 84-4746065
Page 6
APPROVAL
This Estimate has been accepted on __________________ by _____________________
Signature:_________________________________________________________
Panzica Building Corporation Employee Policy Manual - Addendum
Dated October 15, 2024 1
Substance Abuse Policy – Amended
Part 1— Introduction
Purpose
The use of alcohol and other drugs leads to unsafe working conditions for all workers,
as the impaired worker is a potential hazard to himself/herself and to others around.
The purpose of this document is to outline a substance abuse program for Panzica
Building Corporation (the “Company”) which establishes and maintains a safe and
healthy work environment, free from drugs and alcohol. Although this document
provides essential information, it cannot address all situations that may arise.
Once officially adopted, this policy supersedes any prior Company Substance Abuse
Policy. Note that while it is the intention of the Company to comply with state and
federal laws and regulations, where state and federal law differ, however, the
Company will comply with federal laws and regulations.
Benefits
the Company has developed this program to provide the following benefits to the local
construction industry:
Minimize the duplication of effort created by multiple substance abuse programs
that would be necessary were it not for this industry-wide program.
Establish minimum standards for substance abuse programs for contractors and
building trade unions.
Assist owners and contractors in developing substance abuse policies that result in
increased safety for all on-site workers.
ID Card and Database Protocol
Test results from all the Company required testing will be entered into the
Company database. The employee's annual test date is automatically updated
with any negative drug result entry.
A Company ID Card will be issued to employees with a negative test result.
A new card will not be issued each time a test is taken.
A new card will be issued as needed to update an employee's photo and/or replace
a worn unreadable card.
The Company ID Card is the property of the Company. Employers and employees
are to return invalid cards to the Company.
Part 2 — Definitions
The following terms and definitions are provided to ensure a common understanding
of terms and consistency of use:
Accredited Laboratory (SAMHSA). A federally certified laboratory approved by the
Panzica Building Corporation Employee Policy Manual - Addendum
Dated October 15, 2024 2
Federal Department of Health and Human Services (DHHS) for testing prohibited items
and substances.
Accident/Incident. Any event caused by an employee, either directly or indirectly, that
results in treatment by a health care provider, or that resulted in damage to property. This
would also include any serious near-miss incidents.
Adulteration. Tampering with a test sample by the substitution or addition of other
ingredients to mask the presence or use of illegal drugs, resulting in a specimen that
contains a substance that is not expected to be present in human urine, or contains a
substance expected to be present but is at a concentration that it is not consistent with
human urine.
Annual. Each employee's obligation is to be tested at least once every 12 months.
Controlled Substances. Includes all illegal drugs listed in this document with the
Department of Transportation (DOT) limits and includes:
Controlled substances, "look alike" and “designer'' drugs
Prescription drugs, used by a person other than the intended user
Drug paraphernalia
Alcoholic beverages. in the possession of or used by an employee on the
premises, or while assigned to work off premises
Contractor. Employees or subcontractors of a corporation, company, or entity that
performs construction or maintenance work.
Medical Review Officer (MRO). The licensed physician responsible for receiving
laboratory results generated by a substance abuse testing program.
An MRO has:
• knowledge of substance abuse disorders
• received appropriate medical training to interpret and evaluate an individual's medical
history
• been certified by either the American Association of Medical Review Officers
(AAMRO), American College of Occupational and Environmental Medicine
(ACOEM), or Medical Review Officer Certification Council (MROCC).
Company ID Card. A Company ID Card is one that states that it meets the requirements
of the Company substance abuse program, and/or reciprocity with the Company
program, and is verifiable through Company management.
Company ID Card (Counterfeit). A Company ID Card modified in any manner without
authorization from the Company.
Owner. The corporation, company, agency, or other entity, that hires contractors to
perform construction work and/or maintenance work on their premises.
Panzica Building Corporation Employee Policy Manual - Addendum
Dated October 15, 2024 3
Pre-employment Site Entry. Screening of prospective employees to determine if an
applicant is capable of safely performing required tasks and meeting the prerequisites
for employment.
Probable Cause/Reasonable Suspicion. Circumstances based on the objective evidence
about the employee's conduct in the workplace which would cause a reasonable person
to believe that the employee is demonstrating signs of impairment due to alcohol or
other drugs
Substance Abuse Professional (SAP). An SAP can be a:
licensed physician (Medical Doctor or Doctor of Osteopathy)
licensed or certified psychologist
licensed or certified social worker
licensed or certified employee assistance professional
state-licensed or certified marriage and family therapist
drug and alcohol counselor certified by the National Association of
Alcoholism and Drug Abuse Counselors Certification Commission
(NAADAC); or by the International Certification Reciprocity
Consortium/Alcohol and Other Drug Abuse (ICRC); or by the National
13oard for Certified Counselors, Inc. and Affiliates/Master Addictions
Counselor (NBCC).
licensed or certified mental health counselor
Or any additional licensed or certified professional as approved by the
federal government for compliance with the Department of
Transportation's substance abuse program.
An SAP must have knowledge of and clinical experience in the diagnosis and treatment of
substance abuse- related disorders.
Test(s). (Note: All types of tests applicable to the Company program are defined in Part 4)
Part 3 — Tests, Procedures and Supporting Information
Reasons for Testing
Contractors are required to send all drug test results, regardless of the reason for testing,
to the Company to be entered in the Company database.
The types of testing, associated information, guidelines, and time constraints, if applicable,
as required by the Company, are shown below in alphabetical order.
Annual/Pre-employment Test
Each onsite employee is to participate in annual testing or provide
documentation of having been tested within the past 12 months.
The latest test date will become the employee's new annual test date
Panzica Building Corporation Employee Policy Manual - Addendum
Dated October 15, 2024 4
for participation in the Company program.
An employer is prohibited from giving any more than 14 days’ notice of testing to
an employee.
Employers are responsible for notifying employees when their annual test is due.
Follow-up Test
Follow-up testing is required after an employee has taken a return to duty
test. The number of follow- up tests will be set by the SAP.A minimum of 3
is required.
The test results must be negative.
The employee will be notified by telephone or letter to report for testing
no later than the day after receiving notification.
If the employee fails to complete follow-up testing, their Company ID Card
will be marked ''not available" in the Company database and they will be
required to repeat all of the requirements in 4.5 of this policy.
Even though failure to complete the test may be due to the fact that the
employee was laid off or out of the local area (i.e., for vacation), the
employee is responsible for contacting the third party administrator as soon
as possible upon notification of receipt after the fact. The length of time that
was designated by the SAP to complete their follow-up tests will be extended
by the length of time they are non-compliant for not reporting for the test.
The employee is responsible for payment.
Post-Accident/Incident Test
This test is required when the employee is involved in any accident,
incident, or event caused directly or indirectly by the employee that either:
•Results in treatment by a health care provider, or
•Results in damage to property.
This will include any serious near-miss incident
The employee(s) are to proceed directly for testing, or as soon as possible, and
before the employee returns to the job site. It is the
contractor/subcontractor's responsibility to see that testing is done within the
time frame described above.
See Appendix E for additional guidance for Post-Accident/Incident testing.
The employee(s) shall be tested for both drugs and alcohol.
Probable Cause/Reasonable Suspicion Test
This test is required at the time of observable probable cause circumstances
based on objective evidence about the employee's conduct in the workplace
that would cause a reasonable person to believe that the employee is
demonstrating signs of impairment due to alcohol or other drugs.
Examples of objective evidence include an employee showing signs of impairment
such as difficulty in maintaining balance, slurred speech, or erratic behavior, etc.
These observations must be documented, and a copy provided to the employee.
Only supervisors who have had training on determining reasonable suspicion arc
qualified 10 require a reasonable suspicion test.
Panzica Building Corporation Employee Policy Manual - Addendum
Dated October 15, 2024 5
Random Test
The Company shall have contractor employees working on their premises submit
to random drug and alcohol tests.
It is the owner's responsibility to see that their selection is truly random
without discrimination or arbitrary selection.
The Company random testing is to be an unannounced, unscheduled drug and alcohol
test.
Upon notification, the employee must report immediately to the testing facility.
The Company shall give notification of testing to the employee before the end of
a shift to take the possibility of a two (2) hour wait into consideration.
Company random testing should be conducted at levels comparable to
current construction and maintenance activity but must be conducted as
least annually.
Returning to Duty Test
After a positive test result, for an employee to return to work, the employee is
required to take a return to duty test.
The test result must be negative.
The employee is responsible for payment.
Part 4 — Drug Testing Procedures
Specimen Collection
Specimen collection will be conducted in accordance with 49 CFR Part 40
"Procedures for Transportation Workplace Drug and Alcohol Testing Programs",
unless noted otherwise in this policy, and applicable state and federal law.
Testing must be performed by a DHHS-approved laboratory.
the Company does not follow the complete regulatory testing requirements
of the DOT, only the general guidelines. The following urine collection
procedures are followed for the Company program that are different from
DOT:
• Non-federal chain of custody is used.
• Split collection is preferred, but not mandatory.
• If an employee provides an unacceptable specimen (ex. Temperature out of
range), the unacceptable specimen is discarded and NOT sent to the lab for testing
(only the specimen collected under observation is sent to the lab).
• Return to duty and follow-up tests are not required to be collected under
direct observation.
The Company procedures are designed to:
• ensure the security and integrity of the specimen according to accepted
federal DOT chain-of-custody guidelines.
• make every reasonable effort to maintain the dignity of anyone submitting a
specimen for this program.
If an employee is unable to provide a specimen at the time of testing, the
Panzica Building Corporation Employee Policy Manual - Addendum
Dated October 15, 2024 6
employee could be required to wait up to two hours without leaving the test
facility. Failure to remain and complete the test is the same as a refusal to test with
the same sanctions as a positive test result. Make sure that notification of random
testing is given in ample time before the end of a shift.
Types of specimens:
• The employee will provide a urine specimen for the drug test.
• If an employee is physically unable to produce a proper urine sample, a
test may be done by a different method, such as hair, saliva, etc., and must be
approved by the third-party administrator or the Company substance abuse
committee. The employee must present written documentation (see Appendix)
from a medical doctor that supports his inability to provide a urine specimen to
the MRO. The employee or company must contact the third-party
administrator for instructions on how to test using an alternate method.
A photo ID must be presented at the time of collection to verify the employee's identity.
The employee will be asked to empty all pockets and display the contents to the
collector.
The employee will have up to two hours to provide a specimen. If the employee
leaves before the two hours having not provided a specimen, this test will be
processed the same as a refusal to test.
The employee will be afforded privacy to provide the specimen unless:
• The collector observes evidence of an employee's attempt to tamper with a
specimen, or
• The temperature range of the original specimen was out of normal range, or
• It appears that the specimen was tampered with, or
• The specimen was determined invalid by the laboratory
Upon completion of testing the employee will be given a copy of the Custody and
Control Form (CCF).
Laboratory Testing Procedures
All substance analysis will be done in SAMHSA laboratories certified by DHHS.
Laboratory procedures will include:
Initial screen on each specimen. If the initial test is positive a confirmation test will
automatically be performed. A test is considered positive if the detected level of
the drug is at or above the cutoff level shown in Appendix A. The Company
recommends that no adverse action or discipline be taken against any worker or
applicant for employment on the basis of any positive test that has not been
confirmed.
Validity testing is required for each specimen. Each specimen is measured for
creatinine level, specific gravity, and pH to determine if any of the following
occurred:
• Adulterants or foreign substance(s) were added to the urine,
• The specimen was substituted, or
• The urine was diluted.
The laboratory will report all results to the MRO. The MRO will make a final
determination of the verified results. The results will be reported to the
designated employee representative.
Panzica Building Corporation Employee Policy Manual - Addendum
Dated October 15, 2024 7
MRO Procedures
All drug testing shall come under the control and supervision of a physician with
confidentiality protected in accordance with state law and the "AMA Code of Ethical
Conduct for Physicians Providing Occupational Medical Services”. All testing results shall be
verified by an MRO.
The MRO provides a medical review of all test results issued by the laboratory as follows:
If the laboratory result is negative, the review is completed, and a negative result is
reported.
If the laboratory result is positive, adulterated, substituted, or invalid, the MRO will:
• Make one attempt to contact the donor by telephone to inform him of
the results and complete an interview to determine whether a legitimate
medical explanation exists for the result reported by the laboratory.
• If the MRO left a message, but did not talk to the employee by
10:00 AM of the following workday, the MRO will call the employer to
report the results. In any case, the employee always can discuss the test
results with the MRO.
• Ingestion of products that contain hemp will not be an acceptable
explanation for testing positive for marijuana.
If the laboratory reports an invalid result to the MRO, the MRO will contact the
employee and ask if the employee may have taken any medication that may
interfere with some immunoassay tests.
If the employee provides an acceptable explanation, the test will be canceled, and
no further testing will be required unless a negative result is required to obtain a
valid Company ID Card.
If the employee is unable to provide an acceptable explanation and denies
having adulterated the specimen, the test will be canceled, and a second
collection must take place immediately under direct observation
If the laboratory reports a negative result that is also diluted to the MRO, the
MRO will follow the protocol established in Appendix Band direct the
employee to report for another test.
Specimen Retest Protocol
When the MRO has informed the employee of a verified "positive drug test" or
"refusal to test" because of adulteration or substitution, the employee/worker has
72 hours from the time of notification to request a retest of the specimen at a
different SAMHSA laboratory.
The employee may make the request verbally or in writing and make direct
arrangements for payment with the MRO service, as the cost of the test is the
responsibility of the employee.
If the result of the retest is different from the original result, the test will
be cancelled, and a recollection under direct observation will be needed.
Panzica Building Corporation Employee Policy Manual - Addendum
Dated October 15, 2024 8
Part 5 — Alcohol Testing Procedures
Alcohol testing is required for probable cause, post-accident/incident, and for random
testing situations.
Tests for alcohol shall be performed using the breath, saliva, or blood to
determine a Blood Alcohol Content (BAC). If possible, a breathalyzer type
instrument conforming to DOT standards should be used. If not available, then
a blood sample may be used. If blood testing is necessary, the contractor/owner
is responsible to provide a documented reason as to the reasons why a breath
test could not be performed (see Appendix D).
Failure to provide a sufficient breath sample to complete a breath test or
refusing to provide a blood sample will be considered a "refusal to test" and
have the same consequences as a positive test.
All alcohol test results with a confirmed BAC test level of .04 or higher will be
considered positive and will require the employee to be removed from the
owner's property immediately. This result will also invalidate the employee's the
Company ID Card.
For the employee to become eligible for a Company ID Card again. The
employee must complete the required program of rehabilitation outlined in this
document.
All alcohol test results with a confirmed BAC test level of .020 through .039 will
require the employee to be removed from the owner's property for 24 hours or
until the employee's next scheduled work time, whichever is longer.
Any initial test that indicates a BAC level of .02 or greater must be confirmed by
an Evidential Breath Testing Device (EBT) operated by the Breath Alcohol
Technician (BAT). The confirmation test will be performed no sooner than 15
minutes and no later than 30 minutes following the completion of the initial test
in accordance with current DOT guidelines.
Test results
If a test was tampered with by the substitution or addition of other ingredients,
the test result will be processed the same as a positive lest result.
When a recollection is required, i.e., due to adulteration or temperature, etc.,
the recollection will be observed according to DOT procedures.
Diluted Test
A test result that produces a diluted specimen requires a retest. Refer to Appendix
B for detailed instructions on how to process a diluted specimen. If the retest also
produces a diluted specimen, it will carry the same consequences as a positive test
result unless a valid medical reason exists.
Negative Test Result
A drug result is considered negative if:
• the laboratory finds no drug metabolite levels over the confirmed cutoff
values, or
Panzica Building Corporation Employee Policy Manual - Addendum
Dated October 15, 2024 9
• the screen test and confirmation test indicated the presence of a legal
or illegal substance(s) exceeding the limits, but the donor (employee) had a
valid medical reason for the substance being detected in the specimen.
An alcohol result is considered negative if the BAC is below 0.02.
The employee's the Company ID Card will be updated in the Company database.
Positive Alcohol Test
A positive alcohol test occurs if the breathalyzer test, or its equivalent test, indicates the
presence of alcohol that meets or exceeds the cut-off limits of the DOT as shown in this
document.
Positive Drug Test Result
A result is considered positive if the presence of the drug meets or exceeds
both the screening and confirmation levels listed in Appendix A.
The test must be verified by the MRO.
The MRO must determine that the test results are not from the use of any
prescription or over-the-counter medications, food, or any reason other than the
illegal use of unlawful substances or controlled substances.
Refusal to Test
Refusal to submit to a test will carry the same consequences as a positive test. Refusal to
test occurs if an employee:
Adulterated, substituted, or refused to provide a urine specimen
Failed to appear for testing within a reasonable period of time
Failed to remain at the testing site until the testing process was completed
Failed to provide a sufficient amount of urine within 2 hours without a
medical reason and/or failed to undergo an MRO directed medical
evaluation for such a reason
Failed to cooperate with any part of the testing process, which
includes the use of abusive/threatening language or behavior
Disrupted the testing process
Is found to possess or wear a prosthetic or other device that could be used to
interfere with the collection process.
Admits to the collector or MRO that he/she adulterated or substituted the specimen.
Fails to permit an observed collection when required by the program.
Sanctions and Consequences for Failing a Test
The Company requires employees who test positive (including a refusal to test), to
surrender their Company ID Card. The Company will refer employees with positive test
results to an SAP for evaluation and treatment.
The employee must start a program of rehabilitation prior to returning to the Company
site and must continue and complete the rehabilitation in order to be eligible to work on a
Company site. The rehabilitation must include the following steps:
Panzica Building Corporation Employee Policy Manual - Addendum
Dated October 15, 2024 10
1. The employee must arrange for an evaluation with a Substance Abuse Professional (SAP).
2. The SAP evaluation must specify that the employee:
Must attend education classes and/or treatment.
Must perform the actions recommended by the SAP or assigned rehabilitation
specialists.
Is subject to random follow-up testing not less than 3 times within the next 12
month from the employee's return to work test. In cases where the employee was
unable to complete the follow-up test due to being laid off or out of town, etc., the
length of time that was designated by the SAP to complete their follow-up test will
be extended by the length of time the employee was not available for testing.
Will not be allowed to take another the Company drug test for at least 14 days
from the date of the first positive test.
3. The employee is required to submit a letter from the SAP to the Company concerning their
fitness for return to work including that the employee is eligible for a return to duty test.
4. The employee must take a return to duty test with negative results. These results must be
5. submitted to the Company for Company database entry.
6. The employee must actively complete any ongoing rehabilitation and follow-up testing
required by the SAP to keep the Company ID Card valid.
7. Arrangements for all costs are the responsibility of the employee.
8. If an employee tests positive three (3) times within a 12-month period, the employee will
not be eligible to retest or obtain a Company ID Card for a period of one year and will not
be permitted to work on the Company owner property during that period.
9. Failure to comply with any of the above sanctions shall result in the employee surrendering
their Company ID Card. The status of the employee's card will be changed to ”not available"
in the Company database.
10. The result of a person using a counterfeit drug card will be the same as a positive drug test.
Part 6 — Employee Responsibilities
Employee responsibilities are as follows:
Report to work fit for duty.
Be in the appropriate mental and physical condition necessary to work in a safe and
competent manner, free of the influence of drugs and alcohol.
Report to the employer any medications that may impair job performance or safety.
Consent to and participate in Company required tests
Consent to the release of the drug test results to the employer, for the Company database,
or for specific purposes required by law.
Auditing Information
Owners may reserve the right, under conditions of strict confidentiality, to inspect the
Contractor’s substance abuse testing program records within 24 hours of the Owner’s
notification of intent to audit.
Panzica Building Corporation Employee Policy Manual - Addendum
Dated October 15, 2024 11
Part 7 — Employer’s/Contractors’ Responsibilities
Contractors or their employees working on or visiting a Company job site, including
workers, new hires, replacements, and supervisory personnel, are subject to annual
testing, testing for probable cause/reasonable suspicion, post-accident/incident testing,
random testing and return LO duty/follow up testing as a condition of the contract
between the Contractor the Company and the Company and the Owner.
Contractors shall comply with Owner requirements, when such Owner requirements are
more stringent than the Company’s.
The Contractor should provide training to employees, including new hires, to help them
understand the Contractor’s substance abuse testing policy, the effects of substance abuse
on personal health and the work environment. Recognizing the behaviors common to
substance abuse and the procedures for conducting substance abuse testing should also be
included as a part of this training for supervisor personnel who could be required to initiate
a reasonable suspicion/probable cause test.
Contractors are required to maintain a record keeping system that would allow the
Company, or an Owner, or another Contractor with whom the Contractor has entered
into agreement, to effectively conduct a compliance audit.
To protect everyone's legal interest, all Contractors should obtain written consent from
each employee that allows the release of otherwise confidential testing information to
Contractor, the Company, or an Owner.
Panzica Building Corporation Employee Policy Manual - Addendum
Dated October 15, 2024 12
APPENDIX A: Testing Panel
Drugs of abuse are tested in a routine SAMHSA 5-panel screen. Owners and contractors
can choose to test for additional drugs of abuse.
The Company Substance Abuse Program uses the drug screen components and cut-off
levels listed below. In addition to these levels and substances, the creatinine level and
specific gravity of the specimen will be measured.
If the creatinine level is less than 20 mg/dL but greater than 2.0 mg/dL and the specific
gravity is less than 1.0030 but greater than 1.00I0, the sample will be considered dilute,
and another collection will be required. The second sample will be collected the
morning after notification of a diluted specimen.
Adulterated specimens will be processed the same as a positive test.
The minimum requirement for a positive test result for alcohol will be a BAC of
0.04% w/vol., a level consistent with the DOT and CDL guidelines.
New drugs, preliminary cut-off and confirmation levels may be modified periodically in
order 10 parallel the DOT and COL guidelines.
The Company Substance Abuse Program does not follow the complete regulatory
testing requirements of the DOT, only the general guidelines.
Panzica Building Corporation Employee Policy Manual - Addendum
Dated October 15, 2024 13
APPENDIX B: Diluted Specimen Processing
Instructions for Diluted Specimen Retest
A diluted specimen result requires a retest. If this is a second diluted result without a
medical reason, it will be processed the same as a positive test result.
The MRO will report the dilute result to the employer's representative. The employer must
provide specific instructions on fluid intake (see below) to the employee prior to retesting to
prevent another diluted specimen.
The collection for another test must be done the morning after the employee has been notified.
The employee may provide reasons for not being able to test which can be approved by the
database manager. The database manager may reject the explanation. If the employee disputes
the decision of the database manager, the employee can contact Company management to submit
to consider further.
Employee Instruction Prior to Retesting
Here are instructions for the employee to be followed prior to retesting:
Consume no fluids after 9:00 PM the night before the test.
Limit fluid intake to a minimum the day of the test.
The supervisor will inform the employee of the test time and location.
It is the employee's responsibility to monitor intake of fluids to prevent another dilute
specimen.
If the employee has a medical condition that will cause a dilute specimen, the employee's
physician must provide medical information in writing to the MRO for evaluation. After
reviewing the submitted information, the MRO will issue a final report to the employer. Under
the MRO's discretion, a different type of test, i.e. hair test, may be permitted after an individual
has provided two diluted specimens in a row. If a different type of test is ordered, the results of
that test will be used to update the individual's database record.
Panzica Building Corporation Employee Policy Manual - Addendum
Dated October 15, 2024 14
APPENDIX C:
Evaluation Form for Inability to Provide an Adequate Urine Specimen
Purpose of Form: This physician referral form is to be used for an individual who was unable
to provide a sufficient urine specimen within the time allowance stated in the Company
Substance Abuse Policy. The Company policy states that a "refusal to test" will be issued if an
individual is required to take a Company drug test and is unable to provide a sufficient
specimen within the required time, unless the individual can provide a valid medical explanation.
This form provides information to the employee, employer and the evaluation physician on the
steps to be followed for the evaluation. This form should be filled out and given to the
physician who will be doing the medical evaluation.
The Company substance abuse program will follow the same general protocol used by DOT for
handling these types of evaluation. The specific DO1' protocol taken from 49 CFR Part 40.193 is
summarized below and will be used as a guide for the Company evaluations.
Background Information from 49 CFR Part 40.193:
When the collector informs the designated employee representative that an employee has not
provided a sufficient amount of urine, they must, after consulting with the MRO (Medical Review
Officer), direct the employee to obtain, within five working days, an evaluation from a licensed
physician, acceptable to the MRO, who has expertise in the medical issues raised by the employee's
failure to provide a sufficient specimen. If the employee declines to have a medical evaluation, the
MRO will verify the test as a refusal to test.
The referral physician must recommend that the MRO make one of the following determinations:
( 1) A medical condition has, or with a high degree of probability, could have precluded the
employee from providing an adequate amount of urine.
(2) There is not an adequate basis for determining that a medical condition has, or with a high
degree of probability, could have precluded the employee from providing an adequate
amount of urine. (For the purposes of this paragraph, a medical condition includes an
ascertainable physiological condition (e.g., a urinary system dysfunction) or a documented
pre-existing psychological disorder but does not include unsupported assertions of
"situational anxiety" or dehydration.)
Once the referral physician completes their evaluation, they must provide a written statement
of recommendations with a rationale basis to the MRO. This statement should provide only the
essential details of the employee's medical condition necessary to explain their conclusion.
Employee/Employer information:
I. Employee must have an evaluation done by a physician as soon as possible. The
employee must present this form to the evaluating physician. The evaluation should be
done within five working days or else the MRO will be required to issue a refusal to
test. Time extensions beyond the five working days must be approved by the MRO.
2. Employee should sign this consent allowing the physician to release their findings to you and the MRO.
3. Failure to provide an acceptable statement from a physician will result in a refusal to test,
which carries the same consequences as a positive test result.
Panzica Building Corporation Employee Policy Manual - Addendum
Dated October 15, 2024 15
APPENDIX C (continued):
Consent to Release Information (Employee needs to sign)
I, ,SSN , do hereby
authorize the evaluating physician to release the findings of my evaluation to:
Employer's MRO:
Physician's Name Phone Fax
Employer:
Employer's Name Phone Fax
Employee’s Signature: ____________________________________ Date:____________________
Panzica Building Corporation Employee Policy Manual - Addendum
Dated October 15, 2024 16
APPENDIX C (continued):
Physician Information and Instructions:
You have been requested to evaluate the individual indicated below because he/she was
unable to provide an adequate amount of urine to complete a Company required drug test.
Make sure you have read and understand the background information of 49 CFR Part 40.193
on the previous page. Your findings will assist the MRO in determining this individual's final
test status. Please make sure item #1 or #2 below has been completed (and attach any
additional information you believe is pertinent to this evaluation). If you have any questions
regarding this evaluation, please call the Company at 574-234-0124.
Name & SSN (ID#) of employee: __
Employer Name/Address: __
Date employee was unable to complete required drug test: _________________________________
Name (printed) of physician performing evaluation: _______________________________________
Physician Phone: ____________________________ Fax: _________________________________
I have determined, in my reasonable medical judgment, that:
_____ 1. the employee does have a medical condition* that has, or with a high degree of
Probability, could have precluded the employee from providing an adequate amount
urine.
_____ 2. there is not an adequate basis for determining that a medical condition* that has, or
with a high degree of probability, could have, precluded the employee from providing
an adequate amount of urine.
*For purposes of this paragraph, a medical condition includes an ascertainable physiological
condition (e.g., a urinary system dysfunction) or a documented pre-existing psychological
disorder, but does not include unsupported assertions of "situational anxiety" or
dehydration.
Do not include in this statement detailed information on the employee's
medical condition beyond what is necessary to explain your conclusion.
Explanation of finding: __
__
__
__
__
__________________________________________________________________________________
Printed Name of Physician Signature of Physician Date of Conclusion
Panzica Building Corporation Employee Policy Manual - Addendum
Dated October 15, 2024 17
APPENDIX D:
Documentation When a Breath Test Cannot Be Conducted
The Company requires a breath or saliva alcohol test for qualifying Post-Accident/Incident situations,
reasonable suspicion, and immediate random testing situations. the Company has patterned their alcohol
testing requirements after the regulatory testing requirements of DOT (Department ofTranspo11ation).
DOT does not allow the use of blood for alcohol tests except in a few rare circumstances. The FMCSA
(Federal Motor Carrier Safety Administration) division of DOT docs allow employers to accept the results
of breath, saliva, or blood tests conducted by Federal, State, or local officials having independent authority
in Post-accident/Incident situations so long as the results of the tests can be obtained by the employer.
The Company program's policy will allow alcohol testing done by breath or blood. However, breath or
saliva testing is the preferred method. Blood testing is only authorized when a breath or saliva test is
impossible to obtain. The employer is responsible to provide a documented reason to the third party
administrator as 10 why this alternative method (blood testing) was used. The form below can be used
for such documentation and should be forwarded to the third-party administrator.
Name of Employee Date
__________________________________________ _________________________________
Complete explanation of why breath or saliva testing was not done:
The Employee had medical treatment that prevented a breath alcohol test from being
done within the allowed time frame.
There is no testing facility open capable of performing a breath alcohol test within the
allowed time frame. Provide time and location information had medical treatment that
prevented a breath alcohol test from being done within the allowed time frame
__
__
There was no testing facility capable of performing a breath alcohol test within the
geographical area of where the testing needed to occur. Provide time and location
information
__
__
Other, please describe:
__
__
Company name and signature of Employer authorizing agent:
Date __________________________________
Panzica Building Corporation Employee Policy Manual - Addendum
Dated October 15, 2024 18
APPENDIX E: Guidelines for Post-Accident/Incident Testing
Company policy requirement for Post-Accident/Incident Testing:
A substance abuse drug and alcohol test of an onsite contractor employee is required when
they are involved in any accident/incident or event, caused by them either directly or indirectly,
that results in treatment by a health care provider, or that results in damage to property,
including any serious near-miss incident. The employee should proceed directly for testing or
as soon as possible.
Recommended Steps for Post-Accident/Incident Testing:
I. Contractors are responsible for ensuring that a drug and alcohol test is completed for any
accident or incident as defined above.
2. Needed medical treatment will take precedence over completing a drug and alcohol test.
However, a drug and alcohol test should be done as soon as possible. The alcohol test
should be administered within 2 hours of the accident/incident. If there is a delay of more
than 2 hours, an explanation of why the testing was delayed or couldn't be completed
should be documented.
3. The contractor must ensure that the facility who will be doing the post-accident test
meets the following requirements.
a. Drug test requirement:
i. Use of a standard custody and control form
ii. Testing of specimen by a SAMHSA certified laboratory using the drug panel
cut-off level set by CCS
iii. Test result reviewed by a certified MRO (Medical Review Officer)
b. Alcohol Test requirements:
i. A breath test should always be administered unless breath testing is not an
option.
ii. A breath test should be done as soon as possible (within 2 hours). I fit can't be
completed within 8 hours, testing should cease and documentation explaining
the inability to complete testing within 8 hours should be forwarded to the
third-party administrator.
iii. The breath test should be administered by a certified BAT (Breath Alcohol
Technician) using a breath testing device that meets the same requirement as
DOT.
iv If breath testing is not available, a blood draw may be used.
4. The results of all Post-Accident/Incident tests are required to be reported to the third-party
database administrator as soon as possible following any Post-Accident/Incident testing so the
results may be entered into the database.
5. If any Post-Accident/Incident test result is positive the contractor must immediately remove
the employee from the Owner site and follow their Company policy's discipline for testing
positive. Any positive test will render the employee's Company card invalid.
Panzica Building Corporation Employee Policy Manual - Addendum
Dated October 15, 2024 19
APPENDIX F: Fitness For Duty Form
REASONABLE CAUSE/OBSERVATION DOCUMENTATION
All employees, including yourself, occasionally exhibit some performance problems and behavior changes. Sometimes
these problems and changes cause concern that an employee may be unfit to perform the employee's regular duties
as a result of substance abuse. Below is a checklist of some possible observations for you to use in determining when
there is reasonable cause for such concern and possible substance testing. This list is not intended to be all inclusive
nor should you think that one symptom alone automatically means an employee is impaired.
NAME DATE
LOCATION TIME
The onset of one or more of the following observations may be cause for substance abuse testing:
SPEECH AWARENESS BALANCE PHYSICAL INDICATORS
___Incoherent ___Confused ___Swaying ___Pupils dilated/red eyes
___Muddled ___Sleepy ___Staggering ___Cold sweats/tremors
___Slurred ___Erratic behavior ___Falling ___Alcohol/marijuana odor
When you observe behaviors that may interfere with the employee's performance, you should note and
document your observations. The employee should be counseled about performance problems, and any
explanations volunteered or offered by the employee should be noted. Although work related performance or
behavior problems might be cause for substance abuse testing, continued work related performance and
behavior problems might result in reassignment, or discipline up to and including termination of employment.
WORK OBSERVATIONS MOODS PHYSICAL INDICATORS
___ Unexplained or excessive ___Withdrawn/sad/morbid ___ Rapid breathing
absenteeism or tardiness ___ Mood swings high and low ___ Inappropriate wearing of
___ Unexplained or excessive ___ Nervousness/agitation sunglasses
absences from work area ___ Other: ________________ ___ Other: ________________
___ Frequent trips to water _________________________ _________________________
cooler or restroom _________________________ _________________________
___ Difficulty in understanding
/recalling instructions
___ High frequency of accident occurrence
Comments:
To the best of my knowledge and belief this report represents the action, appearance, and/or conduct observed by
me and upon which I base my decision to suggest said employee be tested or be further evaluated by a supervisor.
EMPLOYEE SIGNATURE:
Employee signature is merely confirming that they have been informed of the situation.
SUPERVISOR SIGNATURE:
WITNESS SIGNATURE:
NOTE: THIS REPORT IS TO BE USED ONLY AS AN OBSERVATION AID, AND SHALL, TO THE EXTENT POSSIBLE, REMAIN CONFIDENTIAL.
BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM
Date 10/15/2024
Name Zach Hurst Department DPW
BPW Date 10/22/2024 Phone Extension 3057
Review and Approval Required Prior to Submittal to Board Diversity Compliance
and Inclusion Officer Officer Name BPW Attorney Attorney Name
Dept. Attorney Attorney Name
Purchasing
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 Other: Ease./Encroach
Required Information
Company or Vendor Name
New Vendor Yes If Yes, Approved by Purchasing
No
MBE/WBE Contractor MBE WBE Completed E-Verify Form Attached Yes No Project Name Momentum TIF Project – Site Work
Project Number 124-018
Funding Source River West DA TIF
Account No. PR-00036154
Amount
Terms of Contract Line Item
Purpose/Description Request to open bids for site work package at former Salvation Army building
on Main Street.
For Change Orders Only
Amount of Increase Decrease
$
($ ) Previous Amount $
Current Percent of Change:
Increase
Decrease
%
( %)
New Amount $
Total Percent of Change:
Increase
Decrease
%
( %)
Time Extension Amount: New Completion Date: