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HomeMy WebLinkAboutOpening of Applications - 2025 Sewer Insurance Lateral Repair Program - Bob Frame PlumbingIN LICENSE NO, PC88700840 RME wit PLUMBING SERVICES 2442 JACLYN COURT, SOUTH BEND, INDIANA 46614-3700 Telephone (574) 291-7511 FAX (574) 299-1297 March 7, 2025 Board of Public Works County City Building, Room 1316 227 W. Jefferson Blvd. South Bend, IN 46601 bpwbidsC@southbendin.aov Re: Pre -Qualification Checklist for Water Works Utility Service Line Repair Program &Sewer Insurance Lateral Repair Program To Whom It May Concern: Section (b) (i) IN Secretary of State online copy of Business Entity Information (attached). (ii) Prior business name: Bob Frame Plumbing & Heating, Inc. (iii) No violations within the preceding five (5) years. (iv) We utilize our staff on payroll which consists of members from Local #150 & Local #172, We have 3 operators and 1 apprentice operator, 6 plumbers, 3 plumbing apprentices, 2 maintenance tradesmen and 2 helpers to ensure that we have sufficient employees on staff to complete the work we are bidding on. (v) Individuals who will perform work on the public work project on my behalf will be properly classified as an employee or as an independent contractor under all applicable state and federal laws and local ordinances. (vi) See attached for evidence of participation in apprenticeship and training programs are approved by and registered with the United States Department of Labor's Office of Apprenticeship, or its successor organization. (vii) Written plan for employee drug testing from Local 172 attached. (viii) Statement attached re: utilizing a surety company which is on the Bureau of Fiscal Service " Dept. of Treasury's Listing of approved Sureties". (ix) We do not have any federal, state or local tax liens or tax delinquencies owed to any federal, state or local taxing body in the preceding three years. (i) City of Mishawaka — Similar jobs for both South Bend Water Works Utility Service Line Repairs and South Bend Sewer Insurance Lateral Repairs Thank you for your time and consideration. Sincerely. APPLICATION PRE -QUALIFICATION FOR THE CITY OF SOUTH BEND, INDIANA SEWER INSURANCE PROGRAM Pre -Qualification Category Second Opinion Excavation Special Attach copies of the following documents: 1. License Number 2. Bond letter stating limits for single project and aggregate program 3. (Corp. or LLC Only) Corporate authority and/or proof of registry with the Secretary of State to do business in Indiana Principal Place of autia, �0.Gtl�Ylc� Business: Mailing Address: �me Telephone: Cell: Fax: E-Mail: ( ) X I-rl (JXI) bl\$ (br)q) day c`�Rc 10mb Ownership Information (Identify all owners ifthe Conpae}t rfapplicable) (''h^ b / I�-V i cb P• r�CLrrl�, Csv (p Nature of Company's Business (B,"ie11y describe the type of sel,.ices)aiircoiiilatryprovades) M� c po\-�.l�eluSk�io\ Yie�S (Provide references as needed to validate esperienceforspecific pre-9naliftcation) 14 S, cam OSHA Competent Person Certification (Name ofholder• exphalion date) OSHA Confined Space Training Certification (Name ofholder• expiration date) nn\\\\ n t1Ci.C1'�C� License Information CL" cn (Name ofholder, license type, number) —Tv�&t®X _ P1un,btn�✓ Con1��k�' `TylQc M, �rc3.m2. PC\\�ppD`$D Equipment On Hand (Provide proof of ownership and list of equipment awned by company for use in determination ofpre-qualification) By signing and submitting this application, Uwe agree to follow all City of South Bend Prevailing Specifications and Special Provisions (enclosed in the Sewer Insurance Program Policy as Exhibit G) By signing and submitting this application for pre -qualification, Uwe understand that as a Contractor under the City Sewer Insurance Program, Uwe shall be directly and solely liable to a Homeowner for any damage to any Homeowner's person or property caused by the Contractor's acts, conduct or omissions arising from or within the scope of this Program. Uwe shall release and fully indemnify the City from any claim or cause of action of any kind which Homeowner may make against the City for any act, conduct or omission by the Contractor under this Program. Indemnification includes but is not limited to Contractor's payment of any legal fees or le ex ease incurred by the /jCity �in defending such Homeowner claim. Signatur Stgrmnre Signature U-N�c ,a e, M. rca� IS Title Tide Title 69,INI las 2,io us Dale Dale ExhihitE SEWER INSURANCE CONTRACTOR RATE SCHEDULE February 5, 2025 Pre -qualification category: Second opinion Cable Augering $230.00 Hour Pre -qualification category: Excavation Notes: 1. Total crew size shall be a maximum of two persons unless otherwise approved by the Sewer Insurance Administrator or representative thereof. 2. Equipment costs shall include operator for same. 3. Contractor shall invoice all other material used on an itemized basis. 4. No rate adjustments shall be made for overtime hours nor fees associated with travel time. 5. There will be no fees associated with use of pick-up trucks and trailers. Trip Charge for Excavator $344.00 Job Excavator $172.00 Hour Trip Charge for Other Equipment $143.00 Job Rubber fire backhoe $138,00 Hour Mini Excavator $138.00 Hour Air Compressor $127.00 Job Combination Cleaner Truck $344,00 Hour Compactor (hand) $58.00 Job Dump Truck (20 yd) $103,00 Hour F350 Dump Truck or Similar / Trailer $80.00 Hour Laborer $79.00 Hour Saw Cutting $85.00 Job Trench box, 6' x 6 ' * $161.00 Job Trench box, 8' x 6' * $344.00 Job Trench box, 10' x 16' * $458.00 Job •When needed, steel sheeting included in cost of trench box. Pre -qualification category: Special Special conditions shall be address by the Sewer Insurance AdminisGator tluouglr City of South Bend emergency contracting procedures. 17 Exhibit F SEWER INSURANCE REPORTABLE JOB CATEGORIES BY PRE -QUALIFICATION CATEGORY Pre -qualification category: Second opinion Cable Repair of a Private Sewer through cleanout of the tine by cable machine. Angering Clean -out Install of a clean -out by the Sewer Insurance Program as determined by the Sewer Insurance Administrator Pre -qualification category: Excavation Di Level Definition • Slab home foundation (four to five feet deep) 1 • Repair work performed mainly by hand or backhoe at depths up to five feet • Home has a basement with floor drain 2 • Repair work performed mainly by backhoe at depth frown five to eight feet • Trench box may be required • Home has a basement with floor drain • Repair work may require sidewalk removal and replacement 3 • Repair work requires working around water lines • Repair work performed mainly by backhoe at depth from six to eight feet • Trench box required • Home has a basement with floor drain; basement wall may be between sidewalk and curb line • Repair work may require sidewalk removal and replacement 4 • Repair work requires working around water lines, tree removal required • Repair work performed mainly by backhoe at depth from seven to ten feet • Trench box required Pre -qualification category: Special Dig Level Definikion Home has abasement with floor drain; basement wall may be between sidewalk and curb line; repair work involves work under the street pavement • Repair work may require sidewalk and curb removal and replacement 5 • Repair work requires working around large diameter water lines (24" diameter), large gas mains (six-inch diameter), tree removal required • Repair work perforned mainly by backhoe at depth from nine to 15 feet • Trench box required Replacing long sections of Private Sewer with new pipe or using liner to fix 6 sections of pipe, lE3 X6MVrt G SEWER INSURANCE PROGRAM SPECIAL PROVISIONS PREVAILING SPECIFICATIONS AND DESIGN &CONSTRUCTION STANDARDS The City of South Bend's PREVAILING SPECIFICATIONS, most recent version, and DESIGN & CONSTRUCTION STANDARDS, most recent version, and the INDOT Standard Specifications, current edition with all Supplemental Specifications to date, are to be used in this program. Each contractor is specifically instructed to become completely familiar with the PREVAILING SPECIFICATIONS and the DESIGN & CONSTRUCTION STANDARDS prior to submitting a pre -qualification application. These SPECIAL PROVISIONS will list only "Additions" or "Deletions" to the PREVAILING SPECIFICATIONS and are to be used only in conjunction with the PREVAILING SPECIFICATIONS. hr the event of conflict behveen the SPECIAL PROVISIONS and Hre PREVAILING SPECIFICATIONS, the SPECIAL PROVISIONS will govern. A. Prevailing Specifications/INDOT Staudard Specifications Section: None B. Additions: Where the term "or equal" is used in these specifications, the conUactor deviating from specified item shall file with his/her bid a letter fully explaining and justifying hisArer proposed article or equal with the Sewer Insurance Administrator. The Sewer Insurance Administrator shall be the sole judge in determining if the "or equal" offered meets the specification. ®11►:1.' �! Via] �� I71M A. Prevailing Specifications/INDOT Standard Specifications Section: None B. Additions: 1. Materials and properties purchased under contract with the Owner that becomes a permanent part of the shlichire or facilities conshucted are not subject to the Indiana Gross Retail Tax (Sales Tax). A. Prevailing Specification Staudard Specifications Section: 105 B. Additions: The complete responsibility for this project lies with the Director of Public Works of the City of South Bend, Indiaoa tluough his authorized representatives. 2. Construction Engineering - The Contractor shall provide all the necessary, qualified personnel, equipment and supplies to perform all work required under this item. There will be no direct payment for this item. A. Prevailing Spec ifications/INDOT Standard Specifications Section: 107 B. Additions: The Owner, where mentioned in these documents, is the City of South Bend. The Engineer, where mentioned in these documents, is the South Bend Department of Public Works, acting through its Bureau of Construction. 2. The Contractor shall apply for and obtain any and all required permits for the work from local, state, and federal agencies and shall comply with permit requirements, including the St. Joseph County / City of South Bend Building Department. 3. If the Contractor awarded this contract is not a resident of Indiana, within thirty days, the Contractor shall provide the Engineer with proof that the Contractor is duly licensed, qualified and registered with the Secretary of State of Indiana to engage in business within the State of Indiana. A. Prevailing Specifications/INDOT Standard Specifications Section: 108 B. Additions: 1. hr the event that excessive inclement weather causes a delay in work, the Contractor may apply in writing for an extension of work schedule. The Director of Public Works through his authorized representative will establish all time extensions. 2. Liquidated damages will be assessed at the cost of the day's work on the given day that the work is not completed as assigned or agreed upon. 3. All work will be done between 7:00 a.m. and 6:00 p.m. unless authorized otherwise by the Sewer Insurance Administration. The contractor shall not be paid for travel time and shall not bill for overtime hours. 4. The Contractor shall plan his work and provide signs, barricades, personal notifications, watchmen or any other necessary means to prevent damage to work site by vandals and passers-by. This effort is considered. incidental to the work. No direct payment will be made. A. Prevailing Specifications/INDOT Standard Specifications Section: 103 B. Additions: 1, All Contractors and subcontractors doing business with the City of South Bend shall present a Certificate of hnsurance showing coverage in the following minimum amount: a. General Liability: Premises -Completed Operations or Products, Bodily Injury anA,. Property Damage Combined Single Limit - $1,OOQMCI or $50,000 per person. b. There shall be no exclusion for explosion, collapse or underground hazard. 20 c. Workmen's Compensation: Statutory State of Indiana Employer's Liability - $100,000, d.Auto Liability: Bodily htjury and Property Damage Combined Single limit - $I,000,000. e. City of South Bend shall be named as additional insured on the Certificate. 1_• :►1 WA _ �► ► C J:_ A. Prevailing Specifications/INDOT Standard Specifications Section: None B. Additions: 1. The Contractor shall be responsible fa• providing all materials necessary for the dewatering and protection of existing structures to perform the work included on this project. 2. The Contractor shall submit a Dewatering and Protection of Existing Stuchrres Plau to the Owner and Engineer for review prior to beginning any work affected by the control of ground water and protection of existing structures. The plan shall include drawings, calculations and descriptions, as necessary, to clearly describe the nature of the methods to be used by the Contractor. The plan must be prepared, signed and sealed by a Professional Engineer registered in the State of Indiana, who is experienced in dewatering techniques and support of structures and hydraulic loadings. The plan must be submitted, reviewed and comments addressed adequately before the start of construction. The responsible Professional Engineer shall supervise and monitor the installation and operation of the dewatering/protection of existing structures elements. The Contractor shall have full responsibility for the adequacy of the dewatering methods of the diversion/retention systems used, and for protection of all existing structures. 3. Foundations and all other parts of the construction site shall be dewatered and kept free of standing water and muddy conditions, as necessary, for the proper execution of the work. The Contractor shall install, maintain, and operate all cofferdams, sumps, and other temporary diversion and protective works needed to control ground water and surface water at the site. Since the work will be performed in a residential/conunerciai area, all continuously operating equipment such as pumps and generators must be muffled and enclosed in noise dampening structures so as not to cause a nuisance to nearby residences and commercial establishments. 4. Control of surface and groundwater shall be continuous during the period of construction so that damage to the work shall not occur. Removal of water from the construction site shall be performed so that erosion and the transporting of sediment and other pollutants are minimized. When temporary works used for dewatering are no longer needed, the Contractor shall remove them and return the area to a condition similar to that which existed prior to construction. A. Prevailing Specifications/INDOT Standard Specifications Section: 2001, 2100, 715 and City Standard Drawings WW-2, WW-3, WW-6, WW-7 and WW-8. B. Additions: 1. This work shall entail the removal of conflicting portions of existing sanitary laterals and the reinstatement of said laterals encountered in the progress and prosecution of the work and the installation of new sanitary sewer pipe and laterals and connection to the existing system. 21 2. Where proposed work conflicts with existing private building sewer laterals, a segment of the existing sewer lateral, in conflict, shall be removed and replaced/reinstated. Removal of existing sanitary laterals shall be limited to the first joint upstream and downstream of the portion of work in conflict with the proposed improvements, or as required to tie into existing lateral locations. This work will be measured on a per instance basis for conflicting laterals encountered during the course of the Work and shall include all labor, equipment and materials (including pipe, fittings and couplings). 3. Replacement work materials shall be PVC SDR 35 per ASTM D3034. New sanitary laterals and fittings shall be 6-inch diameter PVC SDR 35 per ASTM D3034 unless otherwise directed by the Owner. The pipe and fittings for the 12-inch and 8-inch Sanitary Sewer shall be PVC SDR 35 per ASTM D3034. 4. The work performed with this Pay Item shall confami to the current City Standards and IDEM's requirements 5. Watertight joints shall be provided at all connections. 6. Installation of the sanitary sewer pipe shall be in accordance with the pipe manufacturer's recommendations, ASTM D2321, the City of South Bend's requirements and IDEM's requirements. Pipe installations shall be backfilled as shown on the Plans or as directed. 7. The termination point of each sanitary sewer lateral shall be marked with a steel reinforcing bar and with'a wood stake. The reinforcing bar shall be size #4, installed flush with proposed grade and shall extend to the center of the sewer lateral pipe. The reinforcing bar shall be offset from the end of the lateral pipe such that it does not touch the pipe. The wood stake shall be pressure treated and shall be 2"x2"x24" long. The top of the stake shall protrude 6"above finish grade. The sanitary sewer lateral markers are incidental to the respective pay item. 8. Leakage tests of the sanitary sewer shall be conducted by the Contractor for infiltration or exfiltration using a hydrostatic test. The hydrostatic test shall be performed with a minimum positive head of 2-feet. The rate of infiltration or exfiltration shall not exceed 100 gallons per inch diameter per mile per day for any section of the system. In lieu of the hydrostatic test, all sanitary sewer piping shall be subject to a low pressure air test per ASTM F1417. The City and Engineer shall be advised 48-hours prior to conducting all tests. 9. A five percent (5%) Mandrel Deflection Test shall be performed on all PVC sanitary sewer pipe. ' 0 10. These pipes shall be mandrelled with a rigid device sized to pass five percent (5%) or less deflection (or defornatiou) of the base inside diameter of the pipe. The Mandrel Test shall be conducted no earlier than thirty (30) calendar days after reaching final trench backfill grade. Each pipe material/type required to be Mandrel tested shall be tested with a Mandrel approved by the pipe manufacturer and meeting the requirements of this section. The test shall not be perfoniied with the aid of a mechanical pulling device. 11. The mandrel shall be pulled by hand through all sewer lines in a manner acceptable to the City and any section of sewer not passing the mandrel shall be uncovered, replaced or repaired to the City's satisfaction and retested. 22 12. The Contractor shall provide proving rings to check the mandrel. Drawings of mandrels with complete dimensions shall be famished by the Contractor to the City upon request for each diameter and specification of pipe. 13. Hypass pumping required to complete the work shall be discharged to the nearest existing sanitary sewer or as directed by the Owner. The sanitary sewer bypass pumping work item shall include all labor, equipment and materials as required to maintain continuous service of the existing sanitary sewer system. The bypass pumping system shall operate such that surcharging and backups of the existing system does not occur. 23 ixhibitH II hen the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit. CONTRACTOR'S NON -COLLUSION AND NON-DEBARP,IENT AFFIDAVIT, CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON-DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS is be completed for all quotes and bids. Please type or print) STATE OF 'Trl3iara ) ) SS: •h COUNTY ) The undersigned Contractor, being duty sworn upon his/her/its oath, affimrs under the penalties of perjury that: 1. Contractor has not, nor has any other member, representative, or agent of the firm, company, corporatiomor partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to nduce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and 2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency; and 3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investment activities in Iran. a. For purposes of this Certification, "Iran" means the government of Iran and any agency or instmmentality of Iran, or as othernise defined at Ind. Code § 5-22-16.5-5, as amended from time - to -time. b. As provided by Ind. Code § 5-22-16.5-8, as amended from thrte-to-time, a Contractor is engaged in inveshnent activities in Iran if either: i. Contractor, its successcr or its affiliate, provides goods or services of twenty million dollars ($20,000,000) or more in value in the energy sector of Iran; or ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty million dollars ($20,000,000) or more in credit to another person for forty-five (45) days or more, if that person will (i) use the credit to provides goods and services in the energy sector in Iran; and (ii) at the time the financial institution extends credit, is a person identified on list published by the Indiana Department of Administration. 4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the Contractor subsequently teams is an unauthorized alien. Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of Contractor's newly hired employees through the &Verify Program as defined by I.C. 22-5-1.7-3. Contractor's documentation of enrollment and participation in the E-Verify Program is included and attached as part of this bid/quote; and 24 5. Contractor shall require his/her/its subcontractors performing work under this public contract to certify that the subcontractors'do not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the subcontractor subsequently learns is an unauthorized alien, and that the subcontractor has enrolled in and is participating in the E-Verify Program. The Contractor agrees to maintain this certification throughout the term of the contract with the City of South Bend, and understands that the City may terminate the contract for default if the Contractor fails to cure a breach of this provision no later than thirty (30) days after being notified by the City. 6. Persons, partnerships, corporations, associations, or joint venturers awarded a contract by the City of South Bend through its agencies, boards, or commissions shall not discriminate against any employee or applicant for employment in the performance of a City contract with respect to hire, tenure, terms, conditions, or privileges of employment, or any matter directly or indirectly related to employment because of race, sex, religion, color, national origin, ancestry, age, gender expression, gender identity, sexual orientation or disability that does not affect that person's ability to perform the work. In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials, or any combination of the foregoing including, but not limited to, public works contracts awarded under public bidding laws or other contracts in which public bids are not required by law, the City, its agencies, boards, or commissions may consider time Contractor's good faith efforts to obtain participation by those Contractors certified by the State of Indiana as a Minority Business ("MBE") or as a Women's Business Enterprise ("WBE") as a factor in determining the lowest, responsible, responsive bidder. In no event shall persons or entities seeking the award of a City contract be required to award a subcontract to an MBE/WBE; however, it may not unlawfully discriminate against said WBE/MBE. A finding of a discriminatory practice by the City's MBE/WBE Utilization Board shall prohibit that person or entity from being awarded a City contract for a period of one (1) year from the date of such determination, and such determination may also be grounds for terminating the contact for which the discriminatory practice or noncompliance pertains. 7. The undersigned contractor agrees that the following nondiscrimination commitment shall be made a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its agencies, boards or commissions. Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the performance of this contract with privileges of employment, or any matter directly or indirectly related to employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation, handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of contract. I, the undersigned bidder or agent as contractor on a public works project, understand my statutory obligations to the use of steel products or foundry products made in the United States (I.C. 5-16-8-1), I hereby certify that I and all subcontractors employed by me for this project will use steel products or foundry products on this project if awarded, I understand that violations hereunder may result in forfeiture of contractual payments. 25 errs I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for public works are true and correct. Dated this Onj day of V ate. , 20AS EEC@ `L Pltxl�ot �CViC.9SrSriC Contractor/Bidde Si ature of Contractor/Bidder or is gent I�iy't 4 P Fcom� , C_ E • D . Printed Name and Title Subscribed and sworn to before me this day of My Commission Expires Notary Public County of Residence a tt P.mef s Nos ry�pu!W S e% oOf indlena =x1gEp��n_ St, Joseph County *••. ►? Commie Ian Number NP07475 O0 �No11j%Jt My COmmlee(On Expires March i5. 2031 26 POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That FEDERATED MUTUAL INSURANCE COMPANY, a corporation duly organized and existing under the laws of the State of Minnesota, and having its principal office in the City of Owatonna, State of Minnesota, does hereby constitute and appoint: KARI GIGSTEAD of MINNESOTA of the City OWATONNA its true and lawful attorney for the following purposes: State Tti sign its name as surety and penalties not exceeding: to, and to execute, affix the seal, acknowledge and deliver any and all surety bonds TWENTY-FIVE THOUSAND DOLLARS ($25,000) EACH BOB FRAME PLUMBING SERVICES INC SOUTH BEND, IN The execution of such bonds or undertakings in pursuance of these presents shall be binding upon the Company as if they had been executed and acknowledged by the regularly elected officers of the Company. This Power of Attorney granted by Federated Mutual Insurance Company shall terminate when the designee ceases to be: I) Employed by Federated Mutual Insurance Company or 2) Employed by Federated Mutual Insurance Company in a job for which such Power of Attorney is required. IN WITNESS WHEREOF, the said FEDERATED MUTUAL INSURANCE COMPANY has caused this instrument to be signed and its corporate seal to be affixed by its Executive Vice President and Assistant Secretary this the 21st day of December 2022 (SEAL) STATE OF MINNESOTA COUNTY OF STEELE FEDERATED MUTUAS.URANCE COMPANY On this 21st day of December , 2022 personally appeared before me, the under"signed notary public, Sean G. Pick and Jonathan R. Hanson to me personally known, who, each being duly sworn by me, did say that they are respectively the Executive Vice President and Assistant Secretary of the FEDERATED MUTUAL INSURANCE COMPANY and that the seal affixed to this instrument is the corporate seal of said Corporation and that this instrument was signed and sealed of behalf of said Corporation by authority of its Board of Directors and said Sean G. Pick and Jonathan R. Hanson acknowledge said instrument to be the free act and deed of said corporation. JENNIFER L. WAYNE i,5 NOTAPYPU6LIC-ldINNESOTA (SEAL) Wcoffim lon Frpires in, Vr 2027 COPY OF RESOLUTION "BE IT RESOLVED that the President or any Vice President in conjunction with the Secretary is hereby authorized and empowered under the corporate seal of the Company, to appoint any person or persons as attorney or attorneys -in -fact, or agent or agents of the Company, in its name and as its act to execute and deliver, anywhere in the United States or Canada, any and all bonds and undertakings of suretyship and other documents that the ordinary course of surety business may require." "BE IT FURTHER RESOLVED that the Power of Attorney or other document appointing such person or persons as attorney or attorneys -in -fact or agent or agents of the Company may either be personally signed by the President, any Vice President, the Secretary or may be executed by said officers by means of facsimile signatures. The said personal signatures or facsimile signatures shall not require the Company seal or any other seal and shall be valid and binding on the company if executed either by personal signature or facsimile signature and with or without the Company seal being affixed thereto." 1, the undersigned, hereby certify that I am a Executive Vice President of the FEDERATED MUTUAL INSURANCE COMPANY, a Corporation duly organized and existing under the laws of the State of Minnesota and that the foregoing is a true and complete copy of the original Power of Attorney given by said Company to: KARI GIGSTEAD of OWATONNA, MINNESOTA authorizing and empowering such person to sign bonds as therein set forth, which Power of Attorney has never been revoked and is still in full force and effect. 1 further certify that said Power of Attorney was given in pursuance of a resolution adopted at a regular meeting of the Board of Directors of said Company duly called and held at the office of the Company in the City of Owatonna, Minnesota on the 20s day of Aoril, 19 82 at which meeting a quorum was present and that the foregoing is a true and correct copy of said resolution, and the whole thereof as recorded in the minutes of the said meeting. PURSUANT to the By -Laws of Federated Mutual Insurance Company, Article 8, Section 1; in the absence of or inability of the Secretary to act, his duties shall be performed by the Assistant Secretaries in the order of their rank. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of the FEDERATED 14TH day of MAY 2024' . MUTUAL INSURANCE COMPANY this the y FEDERATED MUTUAL INSURANCECOMPANY. Executive Vice President Continuation Certificate IN CONSIDERATION of the payment of a premium of $ 100.00 Federated Mutual Insurance Company hereby continues in force to 12-31-2025 its bond No. 0942853 effective 12/31/2015 in the sum of FIVE THOUSAND AND NO/100-- Dollars ($ 5,000.00 ), on behalf of BOB FRAME PLUMBING SERVICES ING represented by (if applicable) Principal, in favor of CITY OF SOUTH BEND BOARD OF PUBLIC WORKS Obligee subject to all its terms, conditions and limitations as set forth and expressed in said bond. This certificate is executed upon the express condition that the Company's liability under said bond and this and all continuation certificates issued in connection therewith shall not be cumulative, and shall not in any event exceed the amount set forth in said bond, or said amount as it may have been increased or decreased by any rider(s) or endorsement(s) properly issued by the Company. Dated this 17TH day of OCTOBER 2024 Federated Mutual Insurance Company * if Renewal Not Desired, Please Return Original Continuation Certificate with Power of Attorney Upon Receiving in Order to Return Premium. FEDE�ITED / oumvGBI PO Box 328 Owatonna, MN 55060 eF-22 Etl. Oi-18 POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That FEDERATED MUTUAL INSURANCE COMPANY, a corporation duly organized and existing under the laws of the State of Minnesota, and having its principal office in the City of Owatonna, State of Minnesota, does hereby constitute and appoint: ItARI GIGSTEAD of the Cityof OWATONNA State of MINNESOTA its tme and lawful attorney for the following purposes: To sign its name as surety to, and to execute, atiix the seal, acknowledge and deliver any and all surety bonds and penalties not exceeding: FIVE THOUSAND DOLLARS ($5,000) EACH BOB FRAME PLUMBING SERVICES INC SOUTH BEND, IN The execution of such bonds or undertakings in pursuance of these presents shall be binding upon the Company as if they had been executed and acknowledged by the regularly elected officers of the Company. This Power of Attorney granted by Federated Mutual Insurance Company shall terminate when the designee ceases to be: I) Employed by Federated Mutual Insurance Company or 2) Employed by Federated Mutual Insurance Company in a job for which such Power of Attorney is required. IN WITNESS WHEREOF, the said FEDERATED MUTUAL INSURANCE COMPANY has caused this instrument to be signed and its corporate seal to be affixed by its Executive Vice President and Assistant Secretary this the 21st day of December , 2022 FEDERATED D.1 (SEAL) STATE OF MINNESOTA COUNTY OFSTEELE COMPANY On this 21st day of December , 2022 personally appeared before Ina, the undersigned notary public, Sean G. Pick and Jonathan R. Hanson to me personally known, who, each being duly sworn by me, did say that they are respectively the Executive Vice President and Assistant Secretary of the FEDERATED MUTUAL INSURANCE COMPANY and that the seal affixed to this instrument is the corporate seal of said Corporation and that this instrument was signed and sealed of behalf of said Corporation by authority of its Board of Directors and said Sean G. Pick and Jonathan R. Hanson acknowledge said instrument to be the free act and deed of said corporation. JENNIFER L. WAYNE NOTARY PUBLIC • MINNESOTA (SEAL) tAY CoaiNssion EvIras Jan. 3192027 "BE IT RESOLVED that the President or any Vice President in conjunction with the Secretary is hereby authorized and empowered under the corporate seal of the Company, to appoint any person or persons as attorney or attorneys -in -fact, or agent or agents of the Company, in its name and as its act to execute and deliver, anywhere in the United States or Canada, any and all bonds and undertakings of suretyship and other documents that the ordinary course of surety business may require." "BE IT FURTHER RESOLVED that the Power of Attomey or other document appointing such person or persons as attorney or attorneys -in -fact or agent or agents of the Company may either be personally signed by the President, any Vice President, the Secretary or may be executed by said officers by means of facsimile signatures. The said personal signatures or facsimile signatures shall not require the Company seal or any other seal and shall be valid and binding on the company if executed either by personal signature or facsimile signature and with or without the Company seal being affixed thereto." I, the undersigned, hereby certify that 1 am a Executive Vice President of the FEDERATED MUTUAL INSURANCE COMPANY, a Corporation duty organized and existing under the laws of the State of Minnesota and that the foregoing is a true and complete copy of the original Power of Attorney given by said Company to: KARI GIGSTEAD of OWATONNA, MINNESOTA authorizing and empowering such person to sign bonds as therein set forth, which Power of Attorney has never been revoked and is still in full force and effect. I further certify that said Power of Attorney was given in pursuance of a resolution adopted at a regular meeting of the Board of Directors of said Company duly called and held at the office of the Company in the City of Owatonna, Minnesota on the 20'n day of ril, 19 82 at which meeting a quorum was present and that the foregoing is a true and correct copy of said resolution, and the whole thereof as recorded in the minutes of the said meeting. PURSUANT to the By -Laws of Federated Mutual Insurance Company, Article 8, Section I; in the absence of or inability of the Secretary to act, his duties shall be performed by the Assistant Secretaries in the order of their rank. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of the FEDI�RATED MUTUAL INSURANCE COMPANY this the 17TH day of OCTOBER 2024 FEDERATED MUTUALINSURANCECOMPANY (SEAL) Executive Vice President CERTIFICATE OF LIABILITY INSURANCE 02/11/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAnvn ONLY nnu cunrhHs nu Nronaa urvn Inc �cn1 rrwrarc r,.....�r.. , ,,.. DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(fes) must have ADDITIONAL INSURED provisions or Be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY P FAX jA,c, No, Eaq:888-333-0949 (a,c, no): 507-046-0664 HOME OFFICE: P,O. BOX 328 OWATONNA, MN 55060 h-MAIL s: CLI ENTCONTACTCENTER®FEDINS.COM.. INSURER A:FEDERATED MUTUAL INSURANCE COMPANV 13935 INSURED INSURER B: BOB FRAME PLUMBING SERVICES INC INSURER C: 2442 JACLYN CT SOUTH BEND, IN 46614-3700 INSURER D: INSURER E: INSURER F: DFVIRION NIIMRER: G THIS IS TO CERTIFY THAT THE POLICIES Of INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR=C] AY NSURANCE RALLIABILITY OCCUR TGEHILAGGREOATE IANDSR SWVD N POLICY NUMBER 9403507 MMIDDIYYY FF 04/01/2025 MMIDDIYYYY 04/01/2026 LIMITS EACH OCCURRENCE $1,000,ODO ; ccurreOe ENTED PREMISES $100000 MEO EXP(MY one Person) EXCLUDED PERSONAL SAov INJURY $1,000000 GENERAL AGGREGATE $2000 OOD IT APPLIES PER: CT ❑LOC PRODUCTS 6 COMP/OP ACC $2,000*000 X AOVMEDAUTOS AUTOMOBILE LIABILITY ANYAUTOBODILY ONLY AMTEEDDULED HIRED AUTOS ONLY NON -OWNED AUTOS ONLY J N N 9403507 04/01/2025 04/01/2026 COMBINED (Ea acclden SINGLE LIMIT l $120001000 INJURY (Per Foram) BODILY INJURY (Per Accidew) F OPAERT YY DAMAGE eso A X UMBRELLA LIAR EXCESS LIM X OCCUR CLAIMS44ADE N N 9403508 04/01/2025 04/01/2026 EACH OCCURRENCE $21000,000 AGGREGATE $21000,000 DEO I RETENTICN A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN MY PROPRIETORIPARTNERI EXECUTIVE OFFICERIMEMBER EXCLUDED? I (hlandalory Ln NN) Uyes, describe under DESCRIPTION OF OPERATIONS below N/A N 9403509 04/01/2025 04/01/2026 X PERSTATUTE I THER E.I.EACH ACCIDENT $50010DO E.DISEASE EA EMPLOYEE $SOO,000 E.L DISEASE POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Addldana Remarks Schedule, may be attacMd it more space is required) THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY. CITY OF SOUTH BEND 22U SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 227 W JEFFERSON BLVD SOUTH BEND, IN 46601-1830 BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo aze registeretl marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 33 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS = AUTOMATIC STATUS WHEN REQUIRED IN A WRITTEN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II -Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and. such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "properly damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. © Insurance Services Office, Inc., 2018 Page 1 of 2 CG 20 33 12 19 Policy Number: 9403507 Transaction Effective Date: 04/01/2025 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement you have entered into with the additional insured; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 2 of 2 ©Insurance Services Office, Inc., 2018 CG 2033 12 19 Policy Number: 9403507 Transaction Effective Date: 04/01/2025 CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK RESPONSIBLE BIDDER CHECKLIST Project Name Project No. For Bids Due Contractor Name: `�6.� rt—c) o V NNk =D k no =UDC The City seeks to enhance its ability to identify responsive and responsible bidders on all City public works projects by institution of comprehensive submission requirements in compliance with State law. Quality workmanship, efficient operation, safety, and timely completion of projects requires that all bidders meet certain minimum requirements to be responsive and responsible bidders. THIS FORM MUST BE SUBMITTED WITH YOUR BID. **THIS FORM ONLY APPLIES TO BIDS GREATER THAN $250,000. ** INSTRUCTIONS: If you are a pre qualified bidder, complete Section I only. If you are not a pre•quallfied bidder, complete Section II only. Section II acts as an application for pre -qualification. Submission of Section II will allow the bidder to be considered for pre -qualification for bids with the City of South Bend Department of Public Works. Pre - qualified bidders will then be exempt from a portion of the submission requirements outlined in Section 6- 71 of The Responsible Bidding Ordinance No. 10975-23 (hereinafter, 'Responsible Bidding Ordinance") for a period of twelve (12) months. Thereafter, contractors who are pre -qualified must submit a complete application for continuation of "pre - qualified" standing, on a form provided by the City (`Responsible Bidder Checklist (1) Pre -Qualified Bidders") within twelve (12) months of obtaining pre -qualified standing. If the status of any item changes within the twelve (12) months, it is the responsibility of the contractor to notify the City. Failure by any pre - qualified contractor to submit its complete application for continuation of "pre -qualified" standing within the time prescribed above shall result in automatic removal of the designation, effective immediately following the twelve (12) months of pre -qualified standing. However, the 'removed" contractor or subcontractor shall still be permitted to bid on City public works projects, though the contractor must submit all required documents under 6-71 until "pre -qualified" status is re-established. Please Note: The City reserves the right to request supplemental information from the bidder, additional verification of any information provided by the bidder, and may also conduct random inquiries of the bidder's current and previous customers regardless of pre -qualified standing. It is the sole responsibility of the potential bidder to comply with all submission requirements applicable to the bidder in Section 6-71 of the Responsible Bidding Ordinance no later than the date of the public bid opening. Version 5/20/2024 POST BID SUBMISSIONS: Post -bid submissions must be submitted in accordance with Section 6-72 of the Responsible Bidding Ordinance. The post -bid submission requirements are as follows: 1. All bidders shall collect, maintain, and provide upon request, a current written list that discloses the name, address, licensing status, and type of work for any subcontractor from whom the bidder has accepted a bid and/or intends to hire on any part of the public work project, including individuals performing work as independent contractors. 2. Each subcontractor, whose portion of the project is estimated to be at least two -hundred fifty thousand dollars ($250,000.00), shall be required to adhere to the requirements of Section I of the Responsible Bidder Ordinance as though it were bidding directly to the City, except that the subcontractor shall submit the required information (including the name, address, and type of work) to the successful bidder prior to the commencement of work. 3. Failure of a subcontractor to submit the required information shall not disqualify the successful bidder from performing work on the project and shall not constitute a contractual default and/or breach by the successful bidder. However, the City may withhold all payment otherwise due for work performed by a subcontractor, until the subcontractor submits the required information and the City approves such information. 4. The disclosure of a subcontractor list ('Disclosed Subcontractor(s)") to the City by a bidder shall not create any rights in the Disclosed Subcontractor(s). Thus, a bidder may substitute another subcontractor for a Disclosed Subcontractor by giving the City, upon request, written notice of the name, address, licensing status, and type of work of the substitute subcontractor. 5. The successful bidder for projects greater than $250,000 and all subcontractors performing work greater than $250,000 on a public works project are required to submit certified payroll utilizing the federal form known as WH-347 or a similar form on a bi-weekly basis, submitted within 10 days after the end of each bi-weekly payroll period. Certified payrolls shall identify the job title and craft for each employee. Certified payrolls shall be submitted electronically. Please Note: Submissions deemed inadequate, incomplete, or untimely by the City may result in the automatic disquacation of the bid. The City, after review of complete and timely submissions, shall, in its sole discretion, after taking into account all information in the submission requirements, determine whether a bidder is responsive and responsible, and provide a Pre -Qualification Verification Letter, The City specifically reserves the right to utilize all information provided in the contractors submission and any information obtained by the City through its own independent verification of the information provided by the contractor. Version 5/20/2024 PRE -QUALIFIED BIDDER CHECKLIST (a) Acknowledgements: (i) _ By checking this box, I hereby acknowledge that I am a pre -qualified bidder with the City of South Bend and that I have met the pre -qualification requirements within the last twelve (12) months. A copy of my Pre -Qualification verification letter is attached. By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided by me, and may also conduct random inquiries of my current and prior customers. By checking this box, I hereby acknowledge that apprenticeship and training programs that I participate in have graduated at least five (5) apprentices in each of the past five (5) years. (iv) _ By checking this box, I hereby acknowledge that all subcontractors performing work greater than $250,000 also meet the qualifications of the Responsible Bidder Ordinance. (b) Attachments: (i) Version 5/20/2024 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). Statement on staffing capabilities, including labor sources. This statement indicates and ensures I have sufficient employees on staff to complete the work. It outlines how I intend to meet the staffing needs of the work. List of projects of similar size and scope of work performed in all areas, including the State of Indiana, within the last three (3) years. For every project, submit evidence of participation in apprenticeship and training programs, applicable to the work to be performed on the project, which are approved by and registered with the United States Department of Labor's Office of Apprenticeship, or its successor organization. This includes, but may not be limited to, letters from apprenticeship coordinators detailing the bidder's association with the program, and the United States Department of Labor Office of Apprenticeship Certificates of Registration of Apprenticeship Programs for each type of work to be performed on the project. II. PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED) (a) Acknow, dg ems: (i) By checking this box, I hereby acknowledge that I am not a pre -qualified bidder with the City of South Bend. By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information additional verification of any information (b) Attachments: _194 Version 5/20/2024 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. 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. 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. 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. 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. sixt Indiana Secretary of State's on-line records (ie. Business verification) dated within y (60) days of the submission of said document showing that business is in existence, current with the Indiana Secretary of State's Business Entity Report, and eligible for a certificate of good standing. (Not applicable to individuals, sole proprietors or partnerships). List identifying all former business names. Any determinations by a court or governmental agency any violations of federal state, or local laws including, but not limited to, violations of contracting or antitrust laws, tax or licensing laws, environmental laws, Occupational Safety and Health Act (OSHA), or federal Davis -Bacon and related Acts, within the preceding five (5) years. Statement about staffing capabilities, including labor sources. This statement ndicates and ensures I have sufficient employees on staff to complete the work I am bidding on OR outlines how I intend to meet the staffing needs of the work. Statement that individuals who will perform work on the public work project on my behalf will be properly classified as an employee or as an independent contractor under all applicable state and federal laws and local ordinances. For every project, submit evidence of participation in apprenticeship and training programs, applicable to the work to be performed on the project, which are approved by and registered with the United States Department of Labor's Office of Apprenticeship, or its successor organization. This includes, but may not be limited to, letters from apprenticeship coordinators detailing the bidder's association with 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) _Jz1 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 4A 3-18-5 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) r/ 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) 1 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. Cl/ (Sigb Here)` (Print Name Here) p 1�71K ,e P�\'MhinQ ..mac- f C!fl_S 1C. (Name of Company) (Address of Compa y) (city) Z� (State) (Telephone Number) Version 5/20/2024 Applications must meet the minimum specifications as provided herein. There is no scoring matrix as all qualified vendors whose applications meet the minimum specifications and who meet and accept the following required conditions will be accepted into the program: • Plumber Contractor License in Indiana; and • Worker's Compensation Insurance; and • Performance bond in the amount of $25,000 or cash bond in the amount of $25,000; and • Proof of Commercial General Liability Insurance per Person in the amount of $50,000; and • Proof of Commercial General Liability Insurance per Occurrence in the amount of $1,000,000 • Three (3) year warranty on all work performed through this program. • Must follow City of South Bend Department of Public Works Design & Construction Standards. • Availability for on -call emergency response scheduled on a weekly rotation which includes before/after normal business hours, weekends and holidays. Emergency repairs require completion within 24 hours. Regular repairs require completion within five working days. • Ability to work in year-round adverse weather conditions. • Must follow IUPPS 811 compliance prior to and throughout all excavation work performed. • Responsible for the planning, set-up and removal or subcontracting of all necessary traffic control according to INDOT requirements found in the Indiana Manual on Uniform Traffic Control Devices and the ability to work safely on heavily trafficked streets. • Must be fully equipped to work safely in underground excavations five feet deep or greater in compliance with OSHA trenching and excavation safety requirements. Company safety manual must be followed and a minimum requirement of two qualified persons for all excavations. • Responsible For repairing all grass/sod property damage caused by excavation work by spreading topsoil and grass seed within two calendar weeks of leak repair. A list of all repairs completed in grass during the winter season must be kept for returning to complete the topsoil and grass seed work at the start of the spring season. CITY OF SOUTH BEND, INDIANA SEWER INSURANCE PROGRAM POLICY Pursuant to Ind. Code § 36-9-6-10, as amended from time -to -time, the City of South Bend, Indiana ("City") acting by and through its Board of Public Works ("Board") is empowered to contract for and maintain all public drains or sewers necessary to carry off the drainage of the City. Chapter 7, Article 7 of the South Bend Municipal Code establishes a sewer service fund ("Sewer Insurance Program") in order to address the repair of failing private sewer connections, and to address administrative and inspection costs associated with the Sewer Insurance Program. The goal of the Sewer Insurance Program is to provide City residents with an affordable insurance program that covers costs to the owners associated with the repair by a private contractor of a lateral sewer connection to a residence with the City sewer system, subject to a deductible that is the responsibility of the property owner. The Board has determined that it is in the best interests of the health, safety, and welfare of its citizens to establish certain policies and procedures in order to ensure proper repair and operation of the City's sewers. The Board has further determined that it is in the best interests of the City to establish procedures for the operational implementation of the Sewer Insurance Program, as well as for pre -qualifying private contractors to perform repairs eligible for recovery under the Sewer Insurance Program. The operational implementation of the Sewer Insurance Program is based on the process established in Chapter 7, Article 7 of the Municipal Code. The pre - qualification of contractors for the Sewer Insurance Program is based upon contractor experience, financial strength, technical expertise, satisfactory past performance and compliance with law. This Policy delegates certain responsibilities to various decision -makers in order to provide for efficient administration and implementation of the Sewer Insurance Program. This Policy is intended to supplement the ordinances establishing the Sewer Insurance Program as same may be amended from time -to -time. 1. The following definitions shall apply to the Sewer Insurance Program a. "Cable Machine" shall mean the sewer cleaning technology used to clear out obstructions to a Private Sewer that meets Second Opinion pre -qualification requirements stipulated in the Table on Page 6. b. "Contractor" shall mean only those contractors meeting the Construction Specifications approved by the City's Board of Public Works (the Board) (see Exhibit G for Construction Specifications) and who have been pre -qualified and pre -approved by the City's Board of Public Works in accordance with this Policy to perform repairs eligible for recovery under the Sewer Insurance Program and are identified on a Registry maintained by the City's Sewer Insurance Program Administrator. c. "Private Sewer" shall mean all connections from the Public Sewer to the foundation wall of the structure located on private property, including any lateral sewer lines flowing into the Public Sewer. d. "Public Sewer" shall mean a sewer which is owned and maintained by the City of South Bend for the collection of sanitary sewer effluent. e. "Registry" shall mean a listing of Contractors that have been pre -qualified and pre -approved by the City's Board of Public Works to perform repairs eligible for recovery under the Sewer Insurance Program. The Registry shall consist of three separate pre -qualification categories as follows: i. Second Opinion Contractor: those contractors who are able to evaluate and perform immediate sewer cleaning and repair work to a Private Sewer ii. Excavation Contractor: those contractors who are able to perform repair of a Private Sewer through open cut excavation iii. Special Contractor: those contractors that are able to provide services that are beyond the 2 requirements of typical repair by excavation (i.e. able to perform excavation at depths greater than eight feet, able to dewater, etc.) f. "Sewer Insm ance Administrator" shall mean the City Manager responsible for the administration, implementation and operation of the Sewer Insurance Program. g. "Repair" shall mean any work performed by the City or its designated Contractor to render a Private Sewer to full operational capacity. All work to inspect the Private Sewer shall be inclusive in the repair work as defined herein. h. "Homeowner" shall mean the person or persons who is/are the title holder of the recorded property deed for the property services by the Private Sewer in question including the beneficial owner under a written, recorded land contract. Z. Program Procedures: City staff and contractors operating under the Sewer hrsurance Program are required to adhere to the following procedures. Failure by a contractor to adhere to these procedures shall result in removal from the Registry. a. A homeowner shall notify the Sewer Department through the City 311 system that their Private Sewer is not functioning correctly. The homeowner or property manager representative shall demonstrate proof that they have attempted to have their Private Sewer repaired by a professional sewer cleaner within 90 days of their 311 call. If the homeowner chooses to clean their Private Sewer with his/her own equipment or rental equipment, this does not qualify as a cleaning that would allow the homeowner to file a claim for sewer insurance. b, Ouce 31 I receives the notification of a sewer backup, the Sewer Department shall inspect the sewer main to determine if the sewer backup was caused by a blockage or other issue with the Public Sewer. c. If the Sewer Department determines that the sewer backup is due to a Private Sewer malfunction, and not the Public Sector, the case shall be referred to the Sewer Lisurance Administrator. d. The Sewer Ltsurance Administrator shall open a Sewer Insurance case for the sewer backup locationI The Sewer Insurance Administrator shall contact the City Water Works for a determination if the homeowner meets the following conditions: i. If the homeowner reporting the sewer backup is in fact the owner of the property in question. ii. If the homeowner is cunent on their Sewer Insurance payments. If the homeowner meets the above conditions, the Sewer Insurance Administrator shall then engage the homeowner under the Sewer Insurance Program, and provide the homeowner with the Right of Entry and Release (Exhibit A), a blank Payment Agreement (Exhibit B), and the Sewer Insurance Information Sheet (Exhibit Q. Homeowners who are not considered "current" by Water Works need to work through the 311 system to address their Water Works account issues prior to receiving service through the Sewer Insurance Program. e. The homeowner shall complete the following actions prior to action being taken under the Sewer Insurance Program to repair the Private Sewer: i. Sign an Agreement for right of entry to property and Release fitrnished by the Sewer Department authorizing right of entry onto the affected private property for purposes of making said repairs and releasing the City from any claim arising from the City's entry onto the property for such repair put -poses (form of which is attached hereto and incorporated herein as Exhibit A); ii. Execute a notarized Payment Agreement (form of which is attached hereto and incorporated herein as Exhibit B) with the City of South Bend Water Works for the payment of the 500 deductible that the homeowner is responsible to pay under the Sewer Insurance Program. f. The Sewer Insurance Administrator shall hire a contractor from the Registry to inspect and repair the Private Sewer. The contractor shall first attempt to clean the line by cable machine. The contractor shalt only be released from their attempt to clean the Private Sewer with cable machine by the Sewer Insurance Administrator or his representative. g. If the contractor successfidly cleans the Private Sewer tlnough cable auger, the City shall reimburse the homeowner any difference in cost actually paid by the homeowner if the contractor's fee is less than the $500 program deductible. If the Contractor's cost is greater than, $500 the City will cover the difference in cost from the sewer service fund. If the total cost of repair is less than $500, the Sewer Insurance Administrator shall readjust the total amount due from the homeowner under any Reimbursement Agreement signed by the homeowner to match the actual fee. h. If the contractor is unsuccessfid in cleaning the Private Sewer tlrrough use of a cable machine, the City may hire the next contractor from the Registry to repair the Private Sewer ttuough excavation. As conditions waraut, the Sewer Insurance Administrator may authorize a new sewer cleanout to be installed on a Private Sewer to facilitate fuhrre clean -out and repair activities on the Private Sewer at no cost to the homeowner minus the cost of the sewer insurance deductible. The homeowner shall ensure that their Private Sewer has an accessible 4h minimum clean -out to allow access by the City and its contractor. Toilets, floor drains, gutter downspouts, or roof vents are not considered acceptable access points. j. The Sewer Insurance Administrator may, as situation warrants, and as recommended by the Health Department, direct work to be performed under the Sewer Insurance Program where conditions in a residence threaten the health of the homeowner, tenants or neighboring residents. In such cases, work may proceed as directed with only a signed Right of Entry and Release form, with payment form to be signed after the work is complete. 3. Program Management a. The Board designates the Sewer Insurance Administrator as the decision -maker and manager charged with daily oversight and administration of the Sewer Insurance Program. The Sewer Insurance Administrator may prescribe and make recommendations concerning the work performed by Contractors listed on the Registry in order to ensure that the work perfomed is cost effective for the City and the property owner, with minimal disruption of City set -vices and operations b. Pre -Qualification Process: The Sewer Insurance Administrator shall accept proposals from contractors who wish to be pre -qualified as a contractor approved to perform repairs eligible for recovery under the City's Sewer Insurance Program. The pre -qualification process shall include the following: (1). Submission of a fully -completed Application for Pre -Qualification for the City of South Bend, Indiana Sewer Insurance Program (form of which is attached hereto and incorporated herein as Exhibit D); and (2). Submission of a financial statement or other evidence of financial responsibility; and (3). Submission of non -collusion affidavit (form of which is attached hereto and incorporated herein as Exhibit F); and (4). Any other documentation or criteria which the Sewer Insurance Administrator, in its sole discretion, requests in order to permit the Sewer Insurance Administrator to evaluate a contractor's experience, financial strength, technical expertise, satisfactory past performance and compliance with law. Applications shall be accepted by the Board on a rolling basis. The Sewer Insurance Administrator reserves the right to request additional information from perspective contractors in order to fully evaluate a contractor's pre -qualification application. The Sewer Insurance Administrator, upon receipt of an application, shall present to the Board for approval to the Registry. The Board shall use its best efforts to approval the vendor's application in a timely fashion. ii. Upon submission of the following, Contractors who are accepted by the Board tluough the pre -qualification process described in Paragraph 3a, shall be listed on the City's Registry for a period up to one year commencing amorally on January V: (1). Performance bond in the amount of $25,000 or cash bond in the amount ofand (2). Proof of Liability Insurance Per Person in the amount of $50,000; and (3). Proof of Liability Insurance Per Occurrence in the amount of $1,000,000; and (4). Worker's Compensation Insurance. The City reserves the right to reject any and all Applications for Pre -Qualification, and refuse to include a contractor on the Registry if the City determines in its sole discretion that the Contractor lacks sufficient experience, financial strength, technical expertise, or equipment to perform work under the City's Sewer Insurance Program, or has failed to comply with applicable statutes, ordinances, rules and regulation, or has failed to completely perform their work satisfactorily. The City may also limit the number of pre -qualified Contractors to be listed on the Registry. iv. In order for a Contractor to renew its listing on the Registry, the Contractor shall submit an updated Application for Pre -Qualification not later than December 151h of the year prior to the renewal term. The Registry shall be continuously updated pursuant to rolling applications, hr order for a Contractor to be approved for listing on the Registry, Contractor must not be under investigation for any criminal behavior by any State or Federal agency. A failure to disclose such investigation may impact a Contractor's determination of "responsible" under I.C. 36-1-2-15.5 on future City Public Work projects. c. Registry Management The Registry shall be maintained at the office of the Sewer Insurance Administrator, with a copy held by the Clerk for the City's Board of Public Works. The Registry shall consist of three separate pre -qualification categories. The categories and pre -qualification requirements are as follows: Prc-Qualification Second Opinion Excavation Definition Those contractors who are able to evaluate and perform immediate repair work to a Private Sewer Those contractors who are able to perform repair work to a Private Sewer through open cut excavation to a maximum depth of nine feet. NOTE: beaching a treuc% e-rcaratiat shell only Ge adharized as mt npproved method oJtrench excavation by the Sewer Insurance Administrator on a case by case basis and will not he ass toned as an authorized practice or teclutique /dr pre -qualification. Prc-qualificatiar Requirements Equipment: • CCTV system (optional) • Cable machine; o Industrial gear driven device or equivalent; o '/a HP motor O 3/4" cable minimum size; ability to clean a minimum of 180' o Four blade cutter (2", 433) o Sharktooth cutter (2", 4" & 6") o Expanding cutter(s) (up to 6" expansion) o Blow bag (optional) o Retrievers (big & small) Experience: Demonstrate experience through reference covering use of required equipment on sewer line repair with a cable machine for lines up to 6" Equipment: • Trench box system to provide trench safety per OSHA at a trench width of four feet (outside width) • Excavation equipment sufficient for a trench width of no more than three feet wide and eight feet deep. Experience: Demonstrate experience through reference regarding sewer line repair trough open cut excavation and appropriate post - construction property restoration. Safety: OSHA confined space training certification Pre -Qualification Category Definition Pre -qualification Requirements OSHA competent person training certification Special Those contractors who are able Equipment: to perform repair work under • Trench box system to the following conditions: provide trench safety per • Dewatering (any depth) OSHA for depths greater • Open cut excavation than eight feet at a trench greater than nine feet deep width of four feet (outside width) • Excavator able to support excavation depths deeper than eight feet with a trench width no greater than four feet. Experience: Demonstrate experience through reference for any special considerations or conditions Safety: OSHA confined space training certification OSHA competent person training certification iii. A co3itractor may be pre -qualified for any combination of the categories within the Registry. iv. The Director of Public Works, or its designee, reserves the right to utilize a contractor not pre -qualified on the Registry ou a conditional basis for emergency purposes only. Such emergency purposes shall be the sole discretion of the Director of Public Works. If such an emergency occurs, the Director of Public Works, or its designee, shall be required to follow Indiana law with respect to the use of an emergency purchase order. A contractor shall have one of the two following pre -qualified conditions assigned by the Sewer Insurance Administrator: (1). Fully pre -qualified: This condition indicates that the Sewer Insurance Administrator has determined that a contractor has demonstrated tlmrouglm actual work, technical skill, equipment on hand, or references that they have the capability to perform the work required for the pre -qualification category in question. (2). Probationary pre -qualified: This condition indicates that the Sewer Insurance Administrator has determined that the contractor has met one of the following situations: (a) The contractor has not demonstrated technical qualifications to the complete satisfaction of the Sewer Insurance Administrator, and is being placed on the Registry provisionally; or (b) The contractor's success rate in repair of a Private Sewer over a rotating six month basis has dropped below 75%; or (c) The contractor was fully pre -qualified, but has not demonstrated the technical competence claimed on the pre -qualification form provided. vi. The Sewer Insurance Administrator shall develop the three categorical lists within the Registry with order of contractors based on the date which their pre -qualification application was received. If multiple applications are received on the same date, contractors for that date shall be listed in the Registry in alphabetical order. vii. The Sewer Insurance Administrator shall call contractors from the Registry in the order each contractor appears on a rotational basis. If a contractor refuses a call, or is unable to respond by the following business day, said contractor shall forfeit until the next rotation. viii. The Sewer Insurance Administrator shall call contractors from the Registry when repair conditions change and the nature of the repair work moves from a Second Opinion to either an Excavation or Special condition. d. If the Sewer Insurance Administrator determines that a Contractor is not fully complying with applicable statutes, ordinances, rule and regulations or whose work has been determined to be unsatisfactory, or lacks sufficient financial strength, equipment or technical expertise to perform the work may be removed from the Registry for a period of up to three years from the date of the violation, and shall not be eligible for cost recovery under the Sewer Insurance Program. e. If either the Board or Sewer Insurance Administrator learn of an ongoing criminal investigation of Contractor after approval to the Registry, the Board is authorized to take action to suspend Contractor from the Registry pending the outcome of such criminal investigation. Reinstatement to the Registry will be subject to the process described under Section 3(f). f. Contractor Notification Process: If a contractor's status in the Registry changes in any way, the Sewer Insurance Administrator shall notify that Contractor of the Sewer Insurance Administrator's determination in writing within ten working days of the alleged violation, or pre - qualification status change. Contractors wishing to appeal the Sewer Insurance Administrator's determination shall file a written appeal to the Board not less than five business days following the date of the Sewer Insurance Administrator's notice to the Contractor. The Board shall hear evidence on the Contractor's appeal at its next regular Board meeting, and the Board's decision shall be final and conclusive unless an appeal is taken as in all other civil matters. The Sewer Insurance Administrator's decision shall be entitled to deference by the Board unless it is arbitrary, capricious, an abuse of discretion, or inconsistent with the rules and regulations of this Program. g. Contractors shall perform construction activities for repair work in accordance with the construction specifications found in Exhibit G of this policy. h. The Director of Public Works, or its designee, may, from time -to -time, make recommendations to the Board concerning the safe and efficient operation of the Sewer Insurance Program, establish certain procedures to ensure that work completed by private contractors under the Sewer Insurance Program is consistent, cost effective and professionally perforated, and shall keep the Board appraised as to unsatisfactory performance of a Contractor listed on the Registry to warrant being removed from the Registry. The Sewer Insurance Administrator shall select contractors from the Registry in a specific order set based on the date and time of application for pre -qualification annually. The order shall rat change unless a contractor is removed from the registry. The Sewer Insurance Administrator may not deviate from the order unless there is a unique situation where the selected contractor may not have uniquely qualifying experience to address. If a contractor is skipped in selection for this reason, they will maintain their place as the next available contractor on the Registry. The contractor selected out of turn will be counted as having performed a service and will be skipped in the normal rotation through the Registry until they come back on the list as the next normally available contractor. A contractor shall respond to the selection for work in a reasonable timeframe (max response timeframe is 24 hours or the next business day whichever is shorter). Contractors unable to respond in a reasonable timeframe shall notify the Sewer Insurance Administrator at the initial request for service. Inability to respond will count as work performed and the Sewer Insurance Administrator shall move to the next contractor on the pre -qualified list. A contractor may be removed from the Registry by the Sewer Insurance Administrator due to a pattern of lack of responsiveness on the part of the contractor. A pattern of lack of responsiveness shall be considered if a contractor does not accept over 50% of selections by the Sewer Insurance Administrator over a period of six months. The Sewer Insurance Administrator shall conduct a quarterly evaluation of contractors on the Registry to maintain a standard of quality performance. Contractors must successfully repair 75% of their cable auger repairs within a sustained six month period to maintain their fully pre - qualified. If a contractor fails to maintain a 75% success rate, they shall be reduced to a probationary pre - qualified status for the next quarter. Should a contractor's performance not improve during the first probationary quarter, the Sewer Insurance Administrator may elect to either remove the contractor for the remainder of the calendar year or grant an additional probationary quarter. A contractor may not have more than two consecutive probationary quarters in a calendar year. If a contractor improves their success rate to 75% or above, they shall be re -instated to a fully pre - qualified status on the Registry. k. The rate schedule for contractor costs incurred while performing work as directed by the Sewer Insurance Administrator as attached hereto under Exhibit E. These rates will be reviewed by the Sewer Insurance Administrator annually and any revisions requested through the Board prior to the beginning of a new calendar year. Contractors may petition the Sewer Insurance Administrator to add or adjust rates within the rate schedule. If petitioned, the Sewer Insurance Administrator shall contact all pre -qualified contractors to determine if additional rate categories are needed. The Sewer Insurance Administrator shall report contractor petitions and response to the Board with recommendation regarding adding additional rates or re -setting the rate amounts. The Sewer Insurance Administrator shall provide a quarterly report to the Board with recommendations and analysis of the program. The quarterly report shall contain the following information: i. Contractor performance: include recommendations as to which jobs/cleanings cannot or should not be held against a contractor for determination of continued competency (provide proof of extreme conditions of the specific situation) ii. Contractor billings per job type. Use Exhibit F for definition of job types and levels of excavation. m. Contractors shall be directly and solely liable to a Homeowner for any damage to any Homeowner's person or property caused by the Contractor's acts, conduct or omissions arising from or within the scope of this Program. Contractor shall release and filly indemnify the City from any claim or cause of action of any kind which Homeowner may make against the City for any act, conduct or omission by the Contractor under this Program. Indemnification includes but is not limited to Contractor's payment of any legal fees or legal expense incurred by the City in defending such Homeowner claim. ExhibitA AGREEMENT FOR THE PURPOSE OF TEMPORARY RIGHT OF ENTRY RELEASE AND INDEMNIFICATION WE, THE UNDERSIGNED, being the Owner(s) and/or Tenant(s) of the real estate described below, give the right, privilege and authority for the purpose of Temporary Right of Entry onto and/or across said real estate for the following purpose: Purpose of Entry: a. For inspection of the private sewer to determine if the line is broken and requires repair and replacement; and b. For making repairs to or replacement of said private sewer line by the City of South Bend, Indiana. Property Location: South Bend, Indiana. (property address) Dates: Beginning on _and ending after The undersigned does/do hereby agree to jointly and severally, release, indemnify and hold the City of South Bend (the City), and its agents, employees, contractors, successors and assigns harmless from all suits, claims or proceedings of any kind, as a result of the City's entry on the above property under this Agreement. This does not include release from damage caused by a Program Contractor performing repair work. The undersigned further acknowledge(s) that this release includes but is not limited to any damage to the foundation, the foundation walls and/or the building line and exterior brick wall resulting from excavation necessary to make repair, and that South Bend Municipal Code Sec. 17-61 expressly requires a property owner to be fully responsible for any repair of the lateral sewer line from inside the basement to the outside exterior brick wall of tine above property. This means that any sewer line break or malfunction which exists under the building foundation is the owner's sole responsibility and is not covered under the City insurance program. Nor does the Sewer Insurance Program cover any costs relating to removal or replacement of trees, shrubbery, plants, lawns, sprinkler systems, or other landscaping features or hard surface improvements such as driveways, patios, and sidewalks, gas grills, and similar items per South Bend Municipal Code See. 17-58. This Agreement shall be interpreted and enforced according to the laws of the State of Indiana. The undersigned persons executing and delivering this Agreement represent and certify that they are the owners or tenants of the said properly amd have the authority to execute and deliver this Agreement and that all necessary action has been taken and done. DATE: OWNERS) / TENANT(S): rm,ee,v„r,�e PrinleA,\'nme Witness: ]0 (Cir)� employee requesting access to property) (printer! name) Exhibit B SEWER REPAIR REIMBURSEMENT AGREEMENT City of South Bend, Indiana Billing Address: Date: Borrower's SSN: I, _ , (Borrower) of _ ,South Bend, Indiana promise to pay to the order of the Sewer Repair Fund, South Bend Water Works, 125 West Colfax Avenue, P.O. Box 1714, South Bend, Indiana 46634, the sum of $500 as follows: One hundred dollars ($100) at the time of the execution of this note, followed by 11 monthly payments of $33.34, and one final payment of $33.26 (total 12), all added to my South Bend water bill at the address listed above which I agree to a. I understand that there will be no interest charged on the amount due pursuant to this note as long as my payments are current, but that during any period of delinquency, I will be charged interest at the rate of eight percent per annum. I hereby waive presentment for payment, protest, notice of protest, and nonpayment of this note, and agree that upon default in payment of this note, or any part when due, the whole amount remaining unpaid shall, without notice or nonpayment or demand of payment, immediately become due and payable, with attorney's fees and without relief whatsoever from valuation of appraisement laws. I understand that if the total cost of repair is less than $500, that Water Works shall amend my payment schedule to match the actual cost of the repairs. Contact Person for Borrower (excluding spouse): BORROWER: Nnme & relatiorrshrp fo Borrower (Plenseprint) (Signature) Telephone No: Telephone No: State of Indiana ) SS: St. Joseph County ) Subscribed and sworn to before me, a Notary Public in and for said County and Statc this day of . 20 Notary Public Cornntission Expiration Date Exhibit C PROPERTY OWNER FACT SHEET CITY OF SOUTH BEND SEWER INSURANCE PROGRAM What is the Sewer Insurance Program? The Sewer insurance Program (the Program) assists South Bend homeowners in the repair of their sewer connection lines from the outside of their building to the City main line usually located under the adjacent street. The repairs covered by the Program are those which do not result fr•onu failure to perform regular maintenance and line cleaning. After a server line is repaired under the Program, the owner is responsible for removal or replacement of any trees, shrubbery, plants, lawns, sprinkler systems, or other landscaping features, and for replacing hard suaface improvements such as asphalt, concrete, or brick driveways, patios, sprinkler systems, gas grills, utility lines, foundations, and any other surface or subsun face improvearents found on public or private property. Who qualifies for the Program If you are a residential water utility customer living in a dwelling with no more than tivo units or a commercial water utility customer, paying for sewer and water service within the City of South Bend, you may have the option of filing a server insurance claim with the City of South Bend If I have a sewer back-up in my home, what is the nrocedure? 1. Ifyou are experiencing aback -up in your home, please call the City's 31 I service center. 2. The City's Sewer Department will determine if the blockage is a result of the City's sewer main or the residential sewer lateral to your home. • 3. If the back-up is due to a blockage in your sewer lateral, you will be advised to first hire a private sewer cleaning contractor to attempt to open up your private lateral line. 4. If this attempt to open up the private lateral fails, the Sewer Insurance Administrator will work with the homeowner to sign up for the City's program, and will arrange for the owner's payment of the required $500 deductible. 5. The repair will be completed by one of the City's approved contractors with the repair and costs monitored by the Sewer Insurance Administrator. Please explain the cost of the Pro rg am: Sewer line repass oJlen cost several thousand dollars. Under tlue Program, the homeowner is responsible only,for• payment of the $500 insurance deductible. Before a Program qualified contactor will repair your sewer connection, you must complete forms and pay the $500 deductible or at least $100. You can arrange to pay the balance in 12 equal installments as part of your water bill by signing a payment agreement. You Hurst also sign a separate form authorizing the City to enter• your property to make repairs. Return the signed forms along with your deductible payment to: South Bend Water Works 125 West Colfitr Avenue P.O. Box 1714 South Bendd, Indiana 46634 The Water Works also can notarize yonrpaynnent agreement if you return it !o !!Henn in person. 12 ExillollD 13 BOB PRAIVIE 1'LUM1IBING SBRI'10ES, Business Name: INC. Entity Type: DntnesEc lrnrvPrnBl CorpnrntLm Creation Onle: 05/16/1975 2442 JACLYN CTI SOUTH BEND, IN, Ptincipal Office Address: 46614.3700, USA Tnrisdiclion ofPorntnlion: Ltdinun BUSRYBSS INFORMATION DIEGO MORALES INDL\NA SECRETARY OF STATE 02/08/2024 02:56 PM Businus ID: 197505.304 Business SlnNm: Active IuacOve Dale: Explmtion llato: Perpetual ➢osiness Entity Report Duo US/Jl{2025 Date: Years Due: Titlm Nnme Address CEO David P Frame 2442 Jaclyn Court, South ➢und, IN, 46614 - 3700, USA President Tyler M. Frame 2442 Jaclyn Court, SouthBend, IN, 46614, USA Vice President Atumnda P. Finnic 2442 Jaclyn Cond, Smnit Bend, IN, 46614, USA Type: ind(vldual Nsnte: DnAdProme Address: 20700 ROCKSTROH ROAD, LAKEVILM IN, 46536 - 0000, USA State of Indiana DMvlkjGrkmrr1IC INFQItiMnTInN Name: Bob Frame Plumbing Services, Inc Ap�R�ss INr-nRM�TIc�N City/State/Zip: South Bend IN 46614-3700 County: Saint Joseph LIChNSE IIVF 0RMAT It7N Lic#: CO81053737 Profession: Plumbing Commission Status: Active Issued: 1/1/1900 Method: Application DISCIRL.INr INI=QRMA1'tC7N R�InATG�17 i..l(:ENSsaS Type: Plumbing Secondary; Corporation Explrat ion: 12/31 /2025 Lic#: PC8870D840 Name: FRAME, DAVID P License Type: Plumber Contractor License Status: Active Relationship: Manager State of Indiana pEMGGRAPHIC INFpRMAtION Name: DAVID P FRAME Ap©RFS:i INI=CSRNiA'11()(J City/Slate/Zip: LAKEVILLE IN 46536 County: Saint Joseph MEW-` IN('OmoNrI©N Lic 4: PC88700840 Profession: Plumbing Commission Status: Active Issued: 5/26/1987 Method: Examination [31SC11'L.IIJk INF0R(S4AfIQN F2C'I_A'i'rp I,ICI:NSFS Type: Plumber Contractor Secondary: Exp Iration: 12/31/2025 Lic#: C081053737 Name: Bob Frame Plumbing Services, Inc License Type: Plumbing Corporation License Status: Active Relationship: Manager Lic N: PA21200241 Name: Claeys-Smith, Adam C License Type: Plumbing Apprentice License Status: Expired Relationship: Employer/Employee Lic 0: PA20802079 Name: Frame, Tyler M. License Type: Plumbing Apprentice License Status: Expired Relationship: Employer/Employee Lit K: PA20802042 Name: Palmer, Steve A License Type: Plumbing Apprentice license Status: Expired Relationship: Employer/Employee State of Indiana DGIVi()C3t�AC�1�lIC INI�(7RM1�A7(©N Name: Tyler MI Prame ADDRE:�B INf-UI�Ml�i1C�N City/State/Zip: Lakeville IN 46536 County: Saint)oseph If,GNS� IN{=f�f�MA"i'IC)N Lic#: PC11200080 Profession: Plumbing Commission Status: Active Issued: 11/9/2012 Method: Examination DI5CIF'I.INI� IN�til�fJf6�i'I(JN P.I�L.AI HD L.IC1=,N;�ES Type: Plumber Secondary: Contractor Expiration: 12/31 /2025 No Related Licenses Continuation Certificate PLUMBING CONTRACTOR IN CONSIDERATION of the payment of a premium of $ 100.00 Federated Mutual Insurance Company hereby continues in force to its bond No. 6075769 07-12-2025 in the sum of TWENTY-FIVE THOUSAND AND NO/100-- Dollars $ 25,000,00 ( ), on behalf of BOB FRAME PLUMBING SERVICES INC effective represented by (if applicable) CITY OF SOUTH BEND BOARD OF PUBLIC WORKS 07/12/2018 vongee sunlect to ail its terms, conditions and limitations as set forth and expressed in said bond. Principal, in favor of This certificate is executed upon the express condition that the Company's liability under said bond and this and all continuation certificates issued in connection therevrith shall not be cumulative, and shall not in any event exceed the amount set forth in said bond, or said amount as it may have been increased or decreased by any rider(s) or endorsement(s) properly issued by the Company. Dated this 14TH day of MAY 2024 Federated Mutual lnsurance Comoanv * If Renewal Not Desired, Please Return Original Continuation Certificate with Power of Attorney Upon Receiving in Order to Return Premium FEDER4TED 15UMINCE17® PO Box 328 Owatonna, MN 55060 BF-22 Etl. O7-18 Providing Service in: INVOICE Andllsfo+: Conunercial, Const/arorion, and Indntsb•ial (OSHA, & Slate OSHA Conplionce) Code RevlenVs /plmn ReviewICC Code Tralnhngfor: Inspectors, Architects, Engineers Safely Consulting: Plant Sgfety, Insurance Connpanies Safety Ratahng: (OSHA, & State OSHA Connpliant) Technical AJOSIes: Ti•alning Expert Witness: Depositions, Con! BYB�)F - JULOVICH, LLC 2311 B. Geyer Rd. Niles, W 49120 TO: DebPriskovlch Bob Frame Plumbing, Inc, 2442 Jaclyn Ct. South Bend, IN 46614-3700 Job Plumber: Verbal P,O, Number: Verbal Job: Training —Training 'PERMS: Due Unon Receipt Invoice Numbel•: 23-1618 to: Oct. 17, 2023 Note: A. service fee of 1.5%per mouth will be added to all accounts with a balance past 10 days. Please payfi'om this invoice, no statement is sent. Please Detach and Return with Remittance 0 - 30 bays 31- 60 bays Over 60 Days y Oct,12, 2023 Confined Space - Refresher $150600 o i en n n Remit To: Bybee-Jnlovicll,LLC 2311 B. Geyer Rd. Niles, MI 49120 Ylefl6e RemitAlnS t�muuut m iw,av Thank You for Your Busin ess! brvoiceNunlber; 234618 Bybee 3ulovlch, L3I ro.3ox39lNlics,An, 49120 pIDcec269.694•0.617 Vox:269-04AM Date: Oct 12, 2023 T omtion: SOuth.Bend, IN Subject: Hazard Communications Company: Bob Frame, Inc. � r u..l.,.., r n n Dv arc PLEASE PRINT YOUR NAME YOWSIGNATURE and your position' . 1, John Doo Sanitary Engineer 2. 3. 4. s. r; 6. 'Iwe v� Squelcw 5 7. 9, �C je,.( /Ivlti✓Lc� � �--- %yam •--" 10. �, � /r��a�✓ 12.l1� ,r 13. 15. 16. 17. 18. 19. '200 21. ;`have signed this at the end of the training sessiml, and confirm that x have understood the content of Ale training session. 1 ExcavattoASa{etyfortompetepipersoh7ralnlnU o+mite pAYP ii039 ' hauttervled ._ how or ban'" s InYamisendF..scaa1ea� ndsloy 2I27/15 _— 7hepesson statedonthls<asdhasattendedtheUnhed kentals Excavation Safaty for Competent porsoniYalnin9 dais, i only their alispioyep Cris designate them the Coanpetont person, A Competent Person Is one whd Is capable of Identlfytng exisung and predictable hazards In the surroundings or rite dangerous to employ esOr orkingcand whoshas the uthoskatlon to ' take prompt cortecuva ll\eeigm5 to ellminato lhehl. 00111tlooliOil Progromu cerilposto or auaWlonvons 1D:001f03003 Looel:172 Trolnlsg rocords mallaule upon Mquuosl. as ,l`eOmila tot Goit'Np6M ~ OvIlllbu FsjIINs prooaae UAOSNA DinutzoU7 hIoweuon toHR tlliit dnSSoclEAtluRi' !!♦r1n�": lcortryno Gvmuod fixNua, rreoaoc 000ifloaUonProgroma 1 IUA08HA 03I M2oae NocVytraib0 1oHH CBIiiBodtoof oualindallons �� TYI_�!2 M pRAMG Ib:00f08P588 Looal:172 Tm6ilng tewMa avallal9a 1ponroquos4 i kot -' Ueamal preerdmt Equipment List - Updated 02-06-24 Quantity Equipment 2 185 Sullair Air Compressor 3 Wacker Jumping Jacks - Compactors 1 Wacker Plate - Compactor 4 Gorlitz HD Sewer Machines 2 .______........- General Jetter Machines _ 1 Picote Maxi Miller Drain Cleaning and Reinstatement_ Machine 1 Vactor Hydro Excavator "Truck (Kenworth) 1 Vac -Con Hydro Excavator - Combo letter - Truck (MAC) 1 Vactor Combination Truck (Peterbilt) 1 Envirosight Camera Truck ...— 2 Envirosight Push Cameras — _ Envirosight Quick View Camera — _1_ 1 Max Liner System Trailer (Line 3" - 24") Sewers and 24' Long Patch — 4 Speed Shore Safety Boxes 5' Deep 16' Deep 1 Kenworth 20-Yard Dump Truck _ 2 5-Yard One -Ton Dump Trucks - -. 1 315 CAT Excavator 1 305 CAT Excavator 1 308 CAT Excavator Attachments, Compactor & Breaker_ 1 T190 Bobcat —_...—.. —. 1 In ersull Rand Light Tower and Generator 3 Mode 400 Concrete Saws—_..-- 1 MillbrConfined Space Equipment 1 L1165 Pipe Laser. 1 Arrow Board Report Selection Criteria: Certification: OSHA10, OSHA30 Cedilled Status: Certified, Expired Contractor Name: Frame Bob Pibg ServicewInc. Plumbers & Pipefitters 172 February oo,2o24 Certification Report Ccrtificntion >;z rb•nlimr Datc: 2I0/2024 09rli0calion certilicatton lAember l0 Full Name Typo rucnl certillcar nName Status Date zYa776T.` . rcaiawl±llRi�aing➢: :.':llpGgrd� ;.;tiZ�..`.�.�r, „gsNA�o„ ., ,� ` ,c�r�iti�d:.: p7/o�t�oq_15,:, 1680566 Frame, Tyler M JY/PF .172 OSHA10 Certified 0311812008 Relnkelll,WilllamA JYtPr vz �or,n�� ���•����� --•-^--�- .'. OSHA30 Cedifled 01f0112090 2607547 Youngs Jacob M JY/PF 772 OSHA30 Cerii(le Numberof Mambos Listed on Report :6 ' ' Page 1 of 7 SOUTH BEND PLUMBERS & PIPEFI'I TERS j OINT APPRENTICESHIP cox TRAINING COMMITTEE 4172 Ralph Jones Court South Bend, IN 46628 Telephone:(574)273-0500 Fax:(574)273-1560 February 6,2024 To Whom It May Concern, Plutbers &Pipefitters Local 172 Joint Apprenticeship &Training Committee (J.A.T.C.) has been registered and certified with the US Depattment of Labor, Bureau of Apprenticeship and Training since December 22, 1941. The Office of Apprenticeship Administration number is N020410001 (please see attached Certificate of Registration). Bob Frame Plumbing Services Inc. became a signatory contractor with Local Union 172 — Plumbers & Pipefitters in 1968 making them also a signatory with our Joint Apprenticeship Training program. Sincerely, Jeremy J. Lucas Apprentice Coordinator :. T Surety Bonds for Contractors February 6, 2024 Re: Bob Frarne Plumbing Services, Inc. To Whom It May Concern: This 1s to advise you that, based upon our current information, we are will(ng to entertain bonds for this organization for construction contracts, subject to the usual underwriting criteria. Bob Frame Plumbing Services, Inc. is in good standing with Granite Re, Inc. Please understand 4hat any arrangement for surety cred(t Is a matter between contractor/applicant and ourselves and we assume no liability to you or any third parties If for any reason we do not supply said bond or bonds. This letter is not an assumption of (lability nor is It a bond. It Is Issued only as a letter of recommendation requested from us by our client. Granite Re, Inc. Is an "A+" rated company by A.M. Best and is a federally approved surety by the United States Department of the Treasury. Sincerely, Granite Re, Inc. Aaron Fischer, AFSB Underwriter 14001 Quallbrook Drive Oklahoma Cliy, Oklahoma y3t34 405/752.26b0 •Fax 405)749.6800 800/440-5953 Webslte: www,gronitere.com [ uit 1_`6 `� _ Z4460 It (offirt of Apprentirrgbtp tp SOUTH BEND PLUMBERS & PIPEFITTERS LOCAL 172 J.A.T.C. SOUTH BEND, INDIANA- FOR THE TRADE CLASSIFICATIONS: PLUMBER, PFPEFITTER, HVACR SERVICE TECHNICIAN 2eyisfereol-os parf of iS( e �iafiona��pprenfices�ip c��sfem in accor&zzzce rvif�fSe 6asrc sfozzo`orols of apprenfices i,o esfa6l"s,6'ed'o' y f2e 6ecrefary of.Savor DECEMBER 22, 1941 aa<a Revised: July 20, 2017 I tT V IN020410001 is�w ^`-;•i o. g .%C¢Jr irl�afian .?G. Yf`�� �`''� '"r' �dminislralof OF.. -r✓! ran6e¢r6i